Candida albicans Flexor Tenosynovitis after Trigger Finger Release: A Case Report

Area of Science:

• Infectious Diseases
• Musculoskeletal Disorders
• Mycology

Background:

• Tenosynovitis, inflammation of the tendon sheath, is uncommon with fungal pathogens.
• Candida species are rarely implicated in tenosynovitis, particularly in immunocompetent individuals.

Observation:

• A case of finger flexor tenosynovitis caused by Candida albicans in an immunocompetent patient is presented.
• The infection occurred following trigger finger release (TFR) surgery, with prior triamcinolone injection potentially contributing.
• Initial tenosynovectomy yielded negative cultures, but a second procedure confirmed Candida albicans.

Findings:

• Delayed diagnosis of Candida tenosynovitis is possible, even with initially negative synovial cultures.
• Invasive procedures like local injections and surgery can be risk factors for fungal tenosynovitis.
• Low-virulence pathogens like fungi should be considered in hand tenosynovitis, irrespective of patient's immune status or initial culture results.

Implications:

• Clinicians should maintain a high index of suspicion for Candida tenosynovitis in patients presenting with hand tenosynovitis after invasive procedures.
• Diagnostic protocols for tenosynovitis should consider fungal etiologies, especially when initial bacterial cultures are negative.
• Early recognition and appropriate antifungal treatment are crucial for managing fungal tenosynovitis to prevent long-term morbidity.