A RARE CASE OF SEPTIC ARTHRITIS WITH RICE BODY FORMATION CAUSED BY CANDIDA ALBICANS IN PREMATURE INFANT

Introduction: The incidence of septic arthritis in children ranges from 5 to 12 cases per 100,000 occurring more frequently in children younger than three years. This condition is usually caused by microrganisms that enter the bloodstream and infect the joint, causing inflammation and pain. Children with immune deficiency disorders have a higher riskof s eptic arthritis. Staphylococcus and Enterobacteriaceae spp. are commonly implicated in septic arthritis. This condition is less frequenting by Candida species. In this report we describe an unusual case of Candida albicans septic arthritis inan infant with rice body formation. Materials and Methods: Our patient was a born prematurely at 30 weeks of gestational age, with a birth weight of about 1000g. When she was two week old showed fever and laboratory examination revealed an increased leukocyte count (12 × 109/l, normal range 3.5-8.8 × 109/l) with eosinophilia (15.2% , normal range 2-4%), an elevated erythrocyte sedimentation rate (25 mm/h, normal range 0-2 mm/h) and increased serum procalcitonin (6 ng/ml, normal range 0-0.1 ng/ml). Candida albicans was isolated from a blood culture. Antifungal drug susceptibility testing were performed using a Vitek 2 system (AST-YS07 cards). The patient received a therapy with fluconazole (16 mg/ml e/v). At 50 days of age the infant showed swelling, warmth, pain and limited range of motion of the left knee and was brought by her parents to the Department of Pediatric Surgery of the University of Messina Polyclinic “G. Martino”. Knee’s ultrasound examination revealed copious effusion with abundant corpuscular bodies. Culture of aspiration fluid on Sabouraud agar revealed Candida albicans while the blood culture was negative. Antifungal drug susceptibility testing was performed using Sensititre YeastOne system and it showed that the yeast was susceptible to all antifungal tested. Intra articular injections with amphotericin B was performed. Discussion: Candida septic arthritis infections are most often due to hematogenous seeding of the joint or bone in patients who have been candidemic and although Candida albicans is the most common pathogen, also other species, such as C. glabrata, C. parapsilosis, and C. tropicalis, can be involved. Conclusion: Candida arthritis is infrequent in infants younger than three months and to our knowledge, this is the first reported case of rice body formation in an infant. Septic arthritis is a serious cause of morbidity and for proper evaluation and treatment, fungal septic arthritis should be included in the differential diagnosis