Fluconazole therapy of oropharyngeal candidiasis in a patient with multiple endocrine failure does not correlate with Candida albicans susceptibility to fluconazole in vitro

Abstract

We report a case of oropharyngeal and oesophageal candidiasis in a 23-year-old man with endocrinopathy syndrome. Multiple episodes of infection were treated with topical miconazole, oral ketoconatole (200 mg daily) or oral fluconazole (50 mg daily) over a period of 7 years. The final episode failed to respond to ketoconazole (200 mg daily) or fluconazole (200 mg daily), but was treated successfully by increasing the fluconazole dose to 400mg daily for 6 months. The patient was maintained on fluconazole 200 mg daily without relapse. Serial Candida albicans isolates from the oral cavity were clonally related by RFLP analyses of genomic DNA, and were resistant to fluconazole, ketoconazole and itraconazole in vitro. We conclude that fluconazole 400 mg daily is effective against oropharyngeal and oesophageal candidiasis in a patient with endocrinopathy syndrome, despite the infecting Candida albicans strains being resistant to azole antifungals in vitro.