Delayed Candida albicans Septic Arthritis in a Pediatric Patient with Cerebral Palsy: A Case Report and Review of the Literature.

Abstract

Fungal septic arthritis is rare, and there is a relative paucity of literature on the subject of joint infections caused by Candida albicans . Most described infections have been in adult patients; to the best of our knowledge, only a few cases have been reported in the pediatric population1. It is known that there is an increased risk for fungal joint infections in people with severe systemic immunosuppression, long-term central venous catheters, and prolonged broad-spectrum antibiotic therapy, as well as with intravenous drug abusers2,3. Hematogenous spread is a common mode of joint seeding, although direct inoculation from trauma or surgery has also been reported4,5. Most commonly, the vertebrae are affected; in the pediatric population, the most common sites of infection are the femur, the humerus, the vertebrae, and the ribs6. These infections can be difficult to diagnose since joint aspirations are often hemorrhagic, and Gram staining is negative in 20% of cases2,5. The synovial white blood-cell (WBC) count can vary widely2, reportedly from 15,000 to 100,000 cells/mL. In the literature, we did not find any reported cases of septic arthritis secondary to Candida albicans occurring in patients with cerebral palsy. We present a case report of a young girl with cerebral palsy who developed monoarticular Candida albicans septic arthritis of the knee two months after treatment for a central line infection. The patient’s parents were informed that data concerning the case would be submitted for publication, and they provided consent. A two-year-old girl with spastic cerebral palsy, necrotizing enterocolitis with a gastric tube, and global developmental delay was admitted to the pediatric intensive care unit (PICU) for respiratory failure secondary to infection from respiratory syncytial virus (RSV). Birth history was remarkable for …