Candidal costochondritis responsive to ketoconazole in an IV drug abuser

Infections caused by Candida albicans have been reported in many organ systems in intravenous drug users. Amphotericin B (Fungizone) has been shown to be effective in treatment. However, because of its numerous side effects and difficulty in maintaining intravenous access in this population, the agent is difficult to use. Ketoconazole (Nizoral), administered orally, is a more convenient and better tolerated agent and was efficacious in the case of candidal costochondritis described here. Further evaluation of ketoconazole is needed to better define its role in the treatment of disseminated candidiasis, particularly in cases associated with intravenous drug abuse.