Sub-acute Septic Arthritis of the Knee by Candida vishwanathii: Two Rare Case Reports and Review of Literature

Introduction: The first mention of Candida vishwanathii dates back to 1959, when it was isolated from the cerebrospinal fluid of a fatal case of meningitis in India. Since its first appearance, information on synovitis of knee by C. vishwanathii, an opportunistic pathogen with low pathogenicity, is only available from one case report in the world. Case Report: A 75-year-old male presented to us with right knee pain of 3 months duration. Examination revealed synovial thickening without a local rise in temperature. Inflammatory markers were not raised. Radiographs suggested osteoarthritis (OA) with periarticular geodes. Initially planned for total knee replacement, intraoperative findings of grossly inflamed synovium prompted deference and complete synovectomy. A 54-year-old male presented similarly with right knee pain and swelling, within 1 month of the first case. Radiologic assessment revealed a medial femoral chondral defect. He was planned for two stage procedure of biopsy with subsequent chondroplasty. In both cases, microbiological testing reported C. viswanathii with the exact same sensitivity patterns. Both were started on oral fluconazole for 6-8 weeks with complete resolution of symptoms at a 6-month follow-up. Conclusion: This is only the second case report on C. vishwanathii and describes the indolent pattern of presentation and review of surgical management of subacute septic arthritis.