Not Available
Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
Candida parapsilosis infection can occur in any surgical setting. We present, to our knowledge, the first case of auricular C parapsilosis chondritis following Mohs micrographic surgery that was successfully treated with an oral antifungal agent (fluconazole).
A basal cell carcinoma of the ear was removed from a 65-year-old man by Mohs micrographic surgery, sparing the perichondrium. Repair was performed with a split-thickness skin graft that was viable 1 week after surgery. The grafted area developed tenderness and erythema 10 days postoperatively while the patient was taking cephalexin. On the 14th postoperative day, the cartilage became exposed and dry, with erythema and edema of the surrounding skin. There were no systemic signs and symptoms. Fenestration of the cartilage with a 3-mm punch biopsy allowed both histopathologic analysis and the establishment of a vascular base for wound granulation.
Perichondrial and cartilaginous invasion by pseudohyphae were demonstrated, and the cultures grew C parapsilosis. Oral fluconazole treatment was initiated (200 mg/d) in addition to continued local wound care. Results of a biopsy taken after 2 weeks of fluconazole treatment showed no fungal invasion, but the wound culture remained positive for C parapsilosis. The oral fluconazole treatment was continued for another 2 weeks. The follow-up culture was negative and the wound healed by second intention with good cosmetic results. The donor site healed without complications. During surgery, no violation of sterility occurred. No other patients undergoing surgery in the same office by the same surgeons developed this infection. Therefore, acquiring the C parapsilosis infection at home during wound care was possible.
Localized and systemic infections with C parapsilosis can occur in several surgical settings, mostly after extensive burns and in the immunocompromised patient. Candida species were isolated from the hands of 29% of hospital personnel working in an intensive care unit, with C parapsilosis being one of the most frequently recovered isolates.1 There is a probability of glove tears with subsequent transmission of the pathogen to patients in any surgical setting.2 Candida parapsilosis is sensitive in vitro to amphotericin B, 5-fluorocytosine, fluconazole, ketoconazole, and itraconazole.3
The auricular cartilage is vulnerable because of its avascular nature, the lack of subcutaneous tissue, and the exposed position of the ear. As a rule, the onset of chondritis is insidious, and usually manifests 3 to 5 weeks after the injury. The therapy for chondritis ranges from topical application of antibiotics to the surgical removal of all involved cartilage. Extensive chondritis can lead to disfigurement of the ear.4 The cartilage of the ear is frequently exposed during Mohs micrographic surgery, and the postoperative course may involve complications if the cartilage is stripped of its perichondrium.
We suggest that when chondritis following auricular surgery is nonresponsive to antibiotic therapy, tissue samples be analyzed for histopathologic characteristics, and routine fungal cultures be considered. These will allow the evaluation for invasive Candida species and other fungi in the setting of nonbacterial infectious chondritis.
Presented at the Eighth European Association of Dermatology and Venerology, Amsterdam, the Netherlands, September 29-October 3, 1999.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Dermatology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.