CANDIDA-ALBICANS ARTHRITIS IN A NONIMMUNOCOMPROMISED PATIENT - COMPLICATION OF PLACEBO INTRAARTICULAR INJECTIONS

A nonimmunocompromised 32-year-old man with arthrosis of the knee part icipated as a placebo control in a clinical trial of intraarticular in jections of hyaluronan. After the fourth weekly injection of saline, h e developed a warm and swollen knee, and synovial fluid cultures revea led growth of Candida albicans. Oral fluconazole treatment was institu ted 2 weeks after onset of symptoms, but failed to eradicate the infec tion. The patient recovered after treatment with local and systemic am photericin B, systemic 5-fluorocytosine and surgical synovectomy. Quan titation of joint cartilage proteoglycan fragments in synovial fluid i ndicated extensive breakdown of cartilage during the acute phase of ar thritis but, parallel to clinical recovery, these levels returned to n ormal.