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Successful management of Candida krusei monoarthritis after allo-SCT

Bone Marrow Transplantation volume 48, pages 1585–1586 (2013)Cite this article

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This led to a dramatic improvement of clinical symptoms, allowing remobilization of the patient and her discharge on day +107 with rapidly decreasing inflammatory signs. Drug levels of voriconazole were adequate (2555 ng/mL) after switching to oral application. Steroids were subsequently tapered and voriconazol subscribed for another 3 months. The patient now is without clinical symptoms and all inflammatory parameters are in the normal range.

Only a few cases of conservative treatment of isolated C. krusei monoarthritis in hematological patients are available.5, 6 To our knowledge, our report is the first one to describe this complication after allo-SCT. Current guidelines recommend antifungal therapy in combination with surgery.4 We here show that aggressive antifungal therapy can successfully treat fungal infection. Moreover, radiological and clinical signs of worsening may be triggered by an inflammatory response sensitive to steroids. Careful evaluation by extensive sampling from inflamed regions and microbiological testing should precede the use of steroids, as these may aggravate the situation in case of persisting fungal infection. Finally, it remains elusive whether a compliance problem, insufficient drug absorption or limited local penetration of posaconazole into the articular cavity initially allowed fungal growth in the knee of our patient. The case highlights that regular blood level screening might be useful to select patients at risk of fungal infections due to insufficient posaconazole blood levels. These patients could benefit from individualized dosing schedules or alternative antifungal prophylaxis strategies (that is, voriconazole).

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Authors and Affiliations

  1. Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany

    K Mayer, M Kapelle, A Kaeferstein, M von Lilienfeld-Toal, P Brossart & D Wolf

  2. Department of Orthopaedic Surgery, University Hospital Bonn (UKB), Bonn, Germany

    M Weßling

  3. Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany

    I Bekeredjian-Ding

  4. Department of Radiology, University Hospital Bonn (UKB), Bonn, Germany

    C Leutner

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  1. K Mayer
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  2. M Kapelle
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Correspondence to K Mayer or D Wolf.

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Mayer, K., Kapelle, M., Kaeferstein, A. et al. Successful management of Candida krusei monoarthritis after allo-SCT. Bone Marrow Transplant 48, 1585–1586 (2013). https://doi.org/10.1038/bmt.2013.108

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