Recurrent vulvovaginal candidiasis associated with long-term tamoxifen treatment in postmenopausal women

BACKGROUND: Symptomatic vulvovaginal candidiasis is rare in postmenopausal subjects because of the estrogen-dependence of this infection. Tamoxifen, a breast-cancer cell estrogen-antagonist, has not previously been reported to predispose to vulvovaginal candidiasis. CASES: Three postmenopausal women, age range 60-81 years (mean 71), were identified with recurrent vulvovaginal candidiasis. In all three cases, new onset of recurrent vulvovaginal candidiasis followed daily tamoxifen therapy. The duration of prior tamoxifen therapy was 1-7 years (mean 3.5). One patient had diabetes mellitus, an additional risk factor for vulvovaginal candidiasis. In all three patients, Candida glabrata was identified as the causal pathogen, although in two patients symptomatic episodes caused by Candida albicans also occurred. In all cases, diagnosis was easily established using conventional investigations, and eradication of vulvovaginal candidiasis was possible without cessation of tamoxifen. CONCLUSION: Long-term tamoxifen treatment may be complicated by recurrent vulvovaginal candidiasis in postmenopausal women.