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Candida parapsilosis Infection after Lumbosacral Arthrodesis with a PEEK TLIF Interbody Fusion Device: Case Report
Marcelo Wajchenberg1,2, Nelson Astur1,3, Michel Kanas1,2
1Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
Abstract:
Spondylodiscitis is an uncommon but serious complication after spine surgeries, and its main etiologic agent is Staphylococcus aureus . Fungal infections are rare and mostly caused by Candida albicans . We report the clinical case of a 69-year-old male patient who underwent a L2-S1 arthrodesis for degenerative scoliosis correction. He presented an infection 2.5 months after the procedure, a spondylodiscitis at L5-S1 levels, caused by Candida parapsilosis . The treatment consisted of surgical material removal, tricortical iliac graft placement in an anterior approach (L5-S1), lumbopelvic fixation (from T10 to the pelvis) in a posterior approach, and drug treatment with anidulafungin and fluconazole. This last medication was administered for 12 months, with good clinical outcomes.
Insights
This case report details a rare fungal spondylodiscitis caused by Candida parapsilosis after spinal surgery. Effective treatment involved surgery and antifungal medications, leading to a positive outcome.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Mycology
Background:
- Spondylodiscitis is a severe complication following spine surgery.
- Staphylococcus aureus is the most common cause of post-operative spondylodiscitis.
- Fungal infections, particularly Candida albicans, are rare but recognized causes.
Purpose of the Study:
- To report a rare case of post-operative spondylodiscitis caused by Candida parapsilosis.
- To describe the management and successful treatment of this fungal infection.
- To highlight the importance of considering fungal pathogens in refractory post-operative spine infections.
Main Methods:
- A 69-year-old male patient underwent L2-S1 arthrodesis for degenerative scoliosis.
- The patient developed spondylodiscitis at L5-S1 levels 2.5 months post-surgery.
- Treatment included surgical debridement, iliac graft, lumbopelvic fixation, and antifungal therapy (anidulafungin and fluconazole).
Main Results:
- Infection was confirmed to be caused by Candida parapsilosis.
- The patient underwent a multi-stage surgical intervention.
- A 12-month course of fluconazole resulted in good clinical outcomes.
Conclusions:
- Candida parapsilosis can cause spondylodiscitis after spinal fusion surgery.
- Aggressive surgical management combined with prolonged antifungal therapy is effective.
- This case underscores the need for broad-spectrum pathogen consideration in post-operative spinal infections.
