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.