FLUCONAZOLE THERAPY OF OROPHARYNGEAL CANDID PATIENT WITH MULTIPLE ENDOCRINE FAILURE DOES NOT CORRELATE WITH CANDIDA-ALBICANS SUSCEPTIBILITYTO FLUCONAZOLE IN-VITRO

We report a case of oropharyngeal and oesophageal candidiasis in a 23- year-old man with endocrinopathy syndrome. Multiple episodes of infect ion were treated with topical miconazole, oral ketoconazole (200 mg da ily) or oral fluconazole (50 mg daily) over a period of 7 years. The f inal episode failed to respond to ketoconazole (200 mg daily) or fluco nazole (200 mg daily), but was treated successfully by increasing the fluconazole dose to 400 mg daily for 6 months. The patient was maintai ned on fluconazole 200 mg daily without relapse. Serial Candida albica ns isolates from the oral cavity were clonally related by RFLP analyse s of genomic DNA, and were resistant to fluconazole, ketoconazole and itraconazole in vitro. We conclude that fluconazole 400 mg daily is ef fective against oropharyngeal and oesophageal candidiasis in a patient with endocrinopathy syndrome, despite the infecting Candida albicans strains being resistant to azole antifungals in vitro.