Infection and Drug Resistance (Jun 2023)
Candida parapsilosis-Caused Arthritis with Rice Body Formation: A Case Presentation and Literature Review
Abstract
Weihui Qi,1,2,* Yanyun Ren,3,* Huang Wang,1,2 Yue Wan,3 Hao Pan,1,2 Jun Yao1,2 1Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China; 3Department of Stomatology No. 903 Hospital of PLA, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jun Yao; Hao Pan, Department of Orthopaedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang Province, 310000, People’s Republic of China, Email [email protected]; [email protected]: A 68-year-old male patient came to the orthopedics department because of swelling and pain in his left shoulder joint. He received more than 15 intraarticular steroid injections in the shoulder joint at a local private hospital. MRI showed that the synovial membrane of the joint capsule was thickened and swollen, and there were extensive “rice body-like” low T2 signal shadows filling. Arthroscopic removal of rice bodies and subtotal bursectomy were performed. The observation channel was placed through the posterior approach, and a large amount of rice bodies in yellow bursa fluid were observed to flow out. Rice bodies with a diameter of approximately 1– 5 mm filled the joint cavity were seen in the observation channel. The histopathological examination of the rice body showed that it was mainly composed of fibrin without a clear tissue structure. Bacterial and fungal cultures of synovial fluid suggested Candida parapsilosis infection, so the patient received antifungal treatment. However, the shoulder swelled again after three weeks, MRI revealed that there was significant fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating and ultrasound examination showed joint cavity effusion, synovial hyperplasia, and some synovium looked like “floating weeds”. After 2 weeks, there were recurrent rice bodies in the articular cavity. Arthroscopic surgery was performed again to clean the joint and a catheter was placed for irrigation and drainage, and a large amount of necrotic synovial tissue floating as seen in ultrasound. Finally, patient received sensitive antifungal treatment and did not relapse within 6 months. During the recurrence in the current case, we recorded the process of rice body formation, which has for the first time been reported.Keywords: rice body formation, Candida parapsilosis, fungal arthritis, intraarticular injection, corticosteroids
