Candida lusitaniae discitis after discogram in an immunocompetent patient

Area of Science:

• Infectious Diseases
• Neurosurgery
• Radiology

Background:

• Discitis and epidural abscess are known, albeit rare, complications following discography.
• While bacterial infections are common, fungal discitis typically affects immunocompromised individuals.
• Management strategies for fungal discitis in immunocompetent patients remain underexplored in medical literature.

Observation:

• A 40-year-old immunocompetent woman developed severe low back pain three weeks post-lumbar discogram.
• MRI revealed L3-L4 discitis; surgical exploration identified an inflammatory mass.
• Intraoperative cultures isolated Candida lusitaniae from the disc and epidural space.

Findings:

• The patient underwent L3-L4 hemilaminectomies and discectomy.
• She successfully completed a six-month course of fluconazole.
• Two-year follow-up showed complete resolution of symptoms and no signs of infection recurrence.

Implications:

• This case highlights the possibility of atypical fungal discitis in immunocompetent hosts post-discography.
• Cultures should be assessed for fungal and mycobacterial pathogens, even in immunocompetent patients with suspected discitis.
• Effective management involves vigilant surveillance, surgical intervention, and appropriate antifungal therapy, leading to favorable long-term outcomes.