Ann Rehabil Med.  2012 Aug;36(4):573-577. 10.5535/arm.2012.36.4.573.

Shoulder Joint Infectious Arthritis and Acromioclavicular Joint Osteomyelitis due to Candida

• Lim KB
• Kwak YG
• Kim YS
• Park KR

• KMID: 2266732
• DOI: http://doi.org/10.5535/arm.2012.36.4.573

Abstract

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. He had undergone multiple injection procedures followed by nonsteroidal anti-inflammatory drug therapy for several weeks. The ultrasonographic findings showed a heterogeneous mass around the right acromioclavicular joint, while the right shoulder MRI and the overall findings of the body bone scan were suggestive of osteomyelitis. Pathologic findings of ultrasonographically guided joint aspiration fluid showed acute and chronic nonspecific inflammation, while the tissue culture and staining revealed Candida parapsilosis.

Keyword

Candida; Osteomyelitis; Shoulder pain

MeSH Terms

Acromioclavicular Joint
Ambulatory Care Facilities
Anti-Bacterial Agents
Arthritis, Infectious
Candida
Central Venous Catheters
Incidence
Inflammation
Joints
Mucous Membrane
Osteomyelitis
Shoulder
Shoulder Joint
Shoulder Pain
Skin
Anti-Bacterial Agents

Figure

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  Fig. 1 (A) Anteroposterior radiograph of the right shoulder shows markedly erosive and sclerotic changes in the acromioclavicular joint, and joint space narrowing in the acromiohumeral joint. (B) Y-view radiograph of the right shoulder shows markedly erosive and sclerotic changes in the acromioclavicular joint.

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  Fig. 2 Whole body bone scan with Tc-99m DPD shows increased radioisotope uptake in the acromial area of the right shoulder.

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  Fig. 3 (A) Short-axis ultrasonographic image of the right humeral head shows a heterogeneous cystic mass around the subacromial bursa. (B) Long-axis ultrasonographic image of the right humeral head shows a heterogeneous cystic mass over the biceps tendon.

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  Fig. 4 (A) Transverse T2 weighted magnetic resonance imaging demonstrates joint erosion with osteomyelitis of the acromioclavicular joint and right shoulder joint. (B) Coronal T1 weighted magnetic resonance imaging shows a rim-enhancing lesion in the right shoulder joint compatible with right shoulder joint infectious arthritis.

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