Multidrug resistant Candida glabrata in an oral lichen planus patient

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 Candida glabrata 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 C. glabrata 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. Candida glabrata, 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 C. glabrata.