J Korean Soc Radiol.  2011 Jun;64(6):587-591. 10.3348/jksr.2011.64.6.587.

Candida Parapsilosis Arthritis Involving the Ankle in a Diabetes Patient: A Case Report1

• Sung J
• Chun KA

• KMID: 1443509
• DOI: http://doi.org/10.3348/jksr.2011.64.6.587

Abstract

Candida parapsilosis is a rare opportunistic fungal pathogen of the musculoskeletal region. Immune function of almost all patients is severely disturbed. Most reported cases of septic arthritis of joints by Candida involve the knee, especially Candida parapsilosis. To our knowledge, there has been only one case report of Candida parapsilosis involving the ankle presented on only plain radiography. We report a case of Candida parapsilosis arthritis involving the ankle in a diabetes patient which was shown on MR imaging.

MeSH Terms

Animals
Ankle
Ankle Joint
Arthritis
Arthritis, Infectious
Candida
Diabetes Mellitus
Humans
Joints
Knee
Magnetic Resonance Imaging
Mycoses

Figure

• 

  Fig. 1 63-year-old woman with candida arthritis. A, B. Anteroposterior (A) and lateral (B) radiographs of the right ankle show asymmetric joint space narrowing and subchondral bone erosion at the posterior and medial aspect of tibiotalar joint (dotted circle). Moderate swelling of soft tissue around the ankle joint is seen. C, D. Sagittal T1-(C) and fat-supressed T2-weighted (D) MR images show joint effusion and synovial thickening. Two loose (rice) bodies (open arrows) are seen within the distended joint space, with iso to slightly high signal intensity on T1-weighted image and low signal intensity on T2-weighted image. Distension of the flexor hallucis longus and tibialis posterior tendon sheaths by fluid collection (solid arrows) represents combined tenosynovitis. Subchondral bone erosion was seen at the posterior aspect of the talar dome (arrowheads). Bone marrow edema (asterisks) is noted in the talus as a low and high signal intensity on T1-and T2-weighted images, respectively. E, F. Four months later, follow-up sagittal T1- (E) and fat suppressed T2-weighted (F) MR images show increased joint effusion and rice bodies within the joint space (open arrows). Destruction of the talar dome by complicated subchondral erosion (arrow heads) is aggravated. Hyperintense bone marrow signals in tibia and talus (asterisks) also progressed, representing concomitant osteomyelitis. G. Axial fat suppressed T2-weighted image at the tibiotalar joint level more clearly reveals abudant hypointense rice bodies (arrows) and a moderate amount of joint effusion.

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  Fig. 2 Photomicrographs of the patients A. Photomicrograph shows chronic granulomatous inflammtion with multinucleated giant cells (hematoxylin and-eosin, magnification ×40). B, C. Photomicrographs for PAS (B) and methenamine-silver (C) staining show several yeast-forming fungal organisms (arrow) (×400).

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