Reccurent vulvovaginal candidiasis in a patient with systemic lupus erythematosus: A case report
Abstract
Background: Recurrent vulvovaginal candidiasis (RVVC) is vulvovaginal infection caused by Candida species with at least four attacks in the last 12 months. Candida glabrata is the most common etiology of non-albicans RVVC. Risk factors for RVVC are immunocompromised conditions such as systemic lupus erythematosus (SLE) and immunosuppressive therapy use. Therapy of RVVC include improvement of risk factors and long-term use of antifungals. This case report aim to report a case of RVVC in a patient with SLE to increase the clinician's knowledge on diagnosis and management of RVVC. Case: A 30-years-old woman complaint of intermittent itchy yellowish vaginal discharge since 1 year ago. The patient has SLE since 6 years ago. Inspeculo examination showed vaginal and cervical erythema accompanied by yellowish white, cheese-like discharge. Direct microscopic examination using 10% KOH showed budding yeast cells and pseudohyphae. Culture examination showed C. glabrata and resistance to fluconazole. The patient was treated with intravaginal nystatin 100.000 iu for 14 days followed by 100.000 iu for 14 days every month. Clinical improvement was found in two months after treatment. Discussion: Recurrent vulvovaginal candidiasis defined as four or more specific episodes within 12 months. Immunosuppressive therapy such as corticosteroid and cyclosporine can increase susceptibility to fungal infection. Direct microscopic examination with 10% KOH and fungal culture can establish the diagnosis of RVVC. Long-term management of fluconazole-resistant candida using intravaginal nystatin is needed to reduce recurrence and morbidities. Conclusion: This case reports a woman with recurrent vulvovaginal candidiasis et causa C. glabrata and systemic lupus erythematosus. The patient was treated with nystatin 100.000 iu intravaginally for 14 days monthly for 6 months. Clinical improvement was found two months after the treatment.References
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