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C4 A complicated case of candida
  1. Fiona Cresswell,
  2. Catherine Kirby,
  3. Deborah Williams
  1. Brighton and Sussex University Hospital, Brighton, UK

Abstract

Background Vulvovaginal candidiasis (VVC) is a common condition caused by Candida albicans in 80–92%. Candida robusta is rarely identified in humans and has only been reported as a cause of VVC in pregnant women. We present a case of chronic Candida robusta VVC.

Case A 25 year-old, on Cerazette, presented to her GP with discharge and vulval itching; treatment with clotimazole was effective but symptoms recurred. In clinic, one month later, a clinical and microscopic diagnosis of VVC was made, she was treated with fluconazole plus econazole pessary and cream. HIV, syphillis, gonorrhoea and chlamydia were negative.

Despite initial improvement she represented with recurrent symptoms, microscopy and culture again confirmed Candida species. Following a fourth presentation oral fluconazole 150 mg every 72 h x 3 followed by a weekly dose for three months was commenced. She was asymptomatic during this time but relapsed on discontinuation. Microscopy again confirmed spores and on speciation Candida robusta sensitive to fluconazole was isolated. A second 3-month fluconazole course was given. She had now developed provoked vulvodynia. Low-grade symptoms persisted and Candida robusta was again cultured, now resistant to fluconazole. A one-week course of oral voriconazole was given. Follow-up microscopy was negative but her vulvodynia had worsened. Treatment with amitriptyline was commenced and on review two months later culture remained negative and her vulvodynia had improved.

Discussion We report a case of chronic Candida robusta VVC in a non-pregnant immunocompetant woman, which acquired fluconazole resistance and precipitated vulvodynia. Speciation and sensitivity testing are important in women with recurrent symptoms.

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