당뇨환자에서 관절강내 스테로이드 주사후 발병한Candida parapsilosis 발목관절염 1예
A Case of Candida Parapsilosis Ankle Arthritis after Intra-articular Steroid Injection
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칸디다종에 의한 감염성 관절염은 비교적 드물게 발생하는 질환이다. 그러나 광범위 항균제 및 면역억제제 사용과 인공 관절 삽입이 증가되면서 발생의 증가가 예상된다. 당뇨병으로 치료중인 53세 여자 환자가 우측 발목 관절에 수차례 스테로이드 정주를 받은후 통증과 부종이 심해져서 입원하였다. 흡입한 관절액에서 Candida parapsilosis가 배양되었고 발목 MRI에서 패혈성 관절염과 관절강내 골에 골수염이 관찰되었다. 환자는 3주간 amphotericin B 정주 후 fluconazole 경구요법으로 7개월 치료하였고 완쾌되었다.국내에서는 4예의 진균성 관절염이 보고되었다. 본 증례환자는 당뇨병외에는 다른 질환을 가지고 있지 않은 상태에서 외상후 발생한 관절염증상으로 반복적으로 관절강내에 스테로이드 주사를 받은 병력으로 인하여 C. parapsilosis 관절염에 이환되었고 내과적 치료만으로 완치되었다.이상에서 저자들은 당뇨환자에서 관절강내 스테로이드 주사후 발생한 C. parapsilosis 감염성 관절염 1예를 기술하였고 문헌고찰과 함께 본 증례를 보고하는 바이다.
Abstract
Candida species are uncommon cause of infectious arthritis. The increasing use of potent antibiotics, immunosuppressives, artificial joints, and especially the injection of steroid into the joints predispose to the fungal arthritis. Candida arthritis occurs by hematogenous dissemination or by direct inoculation of fungus into the joint cavity. Fifty three-year-old diabetic patient, who received intra-articular steroid injection into right ankle joint several times, was hospitalized because of aggravating ankle pain and swelling. Candida parapsilosis was isolated from the joint aspiration fluid and MRI findings were compatible with septic arthritis with osteomyelitis of distal tibia, distal fibula, talus, and calcaneus. The patient was successfully treated with 3 weeks of amphotericin B and 7 months of oral fluconazole. We report this case with review of pertinent literatures, emphasizing a high index of suspicion for the fungal infection in patients with predisposing risk factors.
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