Clin Orthop Surg.  2010 Mar;2(1):59-62. 10.4055/cios.2010.2.1.59.

A Case of Fungal Arthritis Caused by Hansenula Anomala

• Choi SW
• Lee TJ
• Kim MK
• Lee M
• Jung JH

• KMID: 1110351
• DOI: http://doi.org/10.4055/cios.2010.2.1.59

Abstract

Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.

Keyword

Knee; Fungi; Infectious arthritis; Hansenula anomala

MeSH Terms

Aged
Amphotericin B/therapeutic use
Antifungal Agents/therapeutic use
Arthritis, Infectious/*diagnosis/drug therapy/microbiology
Fluconazole/therapeutic use
Humans
*Knee Joint
Male
Mycoses/*diagnosis/drug therapy
*Pichia

Figure

• 

  Fig. 1 Anteroposterior and lateral roentgenograms show mild joint space narrowing but no definite abnormality.

• 

  Fig. 2 Whole body bone scan shows active hot uptake of the knee joint.

• 

  Fig. 3 Arthroscopic finding: severe synovitis and a large amount of necrotic tissue.

Reference

1. Haron E, Anaissie E, Dumphy F, McCreie K, Fainstein V. Hansenula anomala fungemia. Rev Infect Dis. 1988. 10(6):1182–1186.

2. Choi HS, Choi TY. Analysis of 22 cases of Fungemia due to Hansenula anomala. Korean J Clin Pathol. 1996. 16(2):201–210.

3. Murphy N, Buchanan CR, Damjanovic V, Whitaker R, Hart CA, Cooke RW. Infection and colonisation of neonates by Hansenula anomala. Lancet. 1986. 1(8476):291–293.

4. Park SS, Lee SH, Lee MA, Hong KS. Hansenula anomala pneumonia in a patient with lung cancer. Korean J Clin Pathol. 1994. 14(4):463–469.

5. Ma JS, Chen PY, Chen CH, Chi CS. Neonatal fungemia caused by Hansenula anomala: a case report. J Microbiol Immunol Infect. 2000. 33(4):267–270.

6. Taylor GD, Buchanan-Chell M, Kirkland T, McKenzie M, Wiens R. Trends and sources of nosocomial fungaemia. Mycoses. 1994. 37(5-6):187–190.

7. Vicari P, Feitosa Pinheiro R, Chauffaille Mde L, Yamamoto M, Figueiredo MS. Septic arthritis as the first sign of Candida tropicalis fungaemia in an acute lymphoid leukemia patient. Braz J Infect Dis. 2003. 7(6):426–428.

8. Klein JJ, Watanakunakorn C. Hospital-acquired fungemia: its natural course and clinical significance. Am J Med. 1979. 67(1):51–58.

9. Klein AS, Tortora GT, Malowitz R, Greene WH. Hansenula anomala: a new fungal pathogen. Two case reports and a review of the literature. Arch Intern Med. 1988. 148(5):1210–1213.

10. Cuellar ML, Silveira LH, Espinoza LR. Fungal arthritis. Ann Rheum Dis. 1992. 51(5):690–697.