Multidrug resistant <i>Candida glabrata</i> in an oral lichen planus patient

Abstract

Oral lichen planus (OLP) is a mucocutaneous disease characterized by inflammation leading to severe damage to the epithelial basal layer. This report describes a case of a 65-year-old Iranian female with a complaint of multifocal white lesions on the buccal and tongue mucosa with a reticular pattern and a focal pseudomembranous appearance (similar to thrush), together with burning symptoms for fourteen months. The patient was using topical fluocinolone acetonide 0.1%, two to three times a day at least for six months to control the ulcers and erythema. Molecular analysis of the thrush sample revealed <em>Candida glabrata</em> as the causative agent. Histopathologic examination confirmed the diagnosis of OLP. The minimum inhibitory concentration analysis was performed according to CLSI-M60 and revealed that this <em>C. glabrata</em> isolate was multidrug-resistant (resistant to nystatin, fluconazole, micafungin, and caspofungin). Finally, this patient was treated with amphotericin B oral suspension (0.5 g/5 ml) thrice daily for 14 days. The thrush disappeared completely and the patient no longer had any pain or burning sensations. <em>Candida glabrata</em>, the second most common cause of candidemia, is a major opportunistic fungal pathogen of humans that causes systemic as well as, mucosal and superficial infections. This case is the first case of OLP accompanied by multidrug-resistant <em>C. glabrata</em>.