[Clinical problems in medical mycology: Problem number 48]

Area of Science:

• Infectious Diseases
• Dermatology
• Immunology

Background:

• A 42-year-old human immunodeficiency virus (HIV)-positive male with a low CD4(+) T cell count (31 cells/μl) presented with severe lower back pain.
• The patient had a history of diabetes, chronic viral hepatitis B and C, and multiple highly active antiretroviral therapy (HAART) treatments.

Observation:

• Spinal CT revealed lytic bone lesions in L2 and L3, with bone biopsy isolating methicillin-resistant Staphylococcus aureus (MRSA).
• Initial treatment with intravenous vancomycin, corset, and physical rest was initiated.
• Subsequently, the patient developed acute dermatitis with papules, vesicles, scales, and erythema, diagnosed as decubitus candidiasis, with Candida albicans and Candida parapsilosis isolated from skin scales.

Findings:

• Topical treatment with salicylic acid and benzoic acid yielded only partial improvement.
• Oral fluconazole at 200mg daily resulted in a rapid and complete clinical response for the decubitus candidiasis.

Implications:

• This case highlights the potential for opportunistic infections, including fungal skin infections, in immunocompromised individuals with advanced HIV.
• Effective management of secondary fungal infections like candidiasis is crucial for patient recovery and well-being.
• The successful treatment with oral fluconazole underscores its efficacy in managing decubitus candidiasis in immunocompromised patients.