[Candida arthritis: report of two cases]

Candida arthritis is extremely rare. However, there has been a steady increase in the incidence of candida arthritis during the last decade because of increasing candida infections in immunocompromised hosts, drug addicts, premature babies, and those who have received prosthetic joint operations or intraarticular injections of steroids. We report herein two cases of candida arthritis: a 27-year-old man with aplastic anemia and transfusional hemosiderosis, and a 60-year-old man with osteoarthritis who received repeated intra-articular injections of steroids. Definite diagnoses were made after repeated smear examinations of synovial fluids. In the first case, candida arthritis occurred about 2 weeks after an antecedent candidemia. Although the arthritis relapsed once due to inadequate antifungal treatment, it was finally successfully treated with systemic amphotericin B, oral ketoconazole and surgical drainage of the synovial fluid. In the second case, it took several months to make the diagnosis. The patient was also treated with amphotericin B, ketoconazole, and surgery with a satisfactory outcome. We conclude that since candida arthritis is a slow, less destructive joint infection, it can almost always be resolved. Also, late orthopedic complications can be avoided by early diagnosis and prompt treatment, including aggressive antifungal therapy, adequate drainage and necessary surgical intervention.