Introduction
Septic arthritis resulting from fungal infection is poorly documented in
the veterinary literature with only 6 previous reports (Riley et
al. 1992, Madison et al. 1995, Swerczek et al. 2001,
Sherman et al. 2006, Cohen et al. 2008, Doyle et
al. 2013). The distinct lack of literature presents clinicians with a
therapeutic dilemma when faced with such cases, as it is not possible to
learn from the successes and importantly, failures of our colleagues.
Historically, treatment has included surgical debridement and
arthroscopic lavage in conjunction with local and systemic antifungal
chemotherapy (Cohen et al. 2008). Safety data are deficient for
the intra-articular use of many anti-fungal chemotherapeutics,
highlighting the importance of documenting the clinical particulars of
this case.
The human literature offers a greater source of relevant literature on
fungal septic arthritis cases with risk factors identified to include
recent administration of antibiotics (within 90 days)(Riaz et al.2020) and corticosteroid administration (Kohli and Hadley 2005). Despite
appropriate medical and surgical therapy, there is a high risk of
recurrence(Henry et al. 2017). The most commonly isolated fungal
organisms in human patients with fungal septic arthritis areCandida species (Bariteau et al. 2014) and this certainly
appears to correlate with the limited equine literature. A full review
of the literature is out with the scope of this case report.
This case report aims to document the diagnosis and unsuccessful
management of an iatrogenic septic fungal arthritis caused byWickerhamomyces anomalous (formerly Candida pelliculosa )
and concurrent OCD lesion at the distal intermediate ridge of the tibia
(DIRT) over 126 days. This report is unique in that it describes the
findings from a known cause through to extensive post-mortem findings
and in doing so offers a greater insight into the patholophysiology of
such cases.