Candida glabrata vertebral osteomyelitis following L3-4 transforaminal lumbar fusion: illustrative case

Candida vertebral osteomyelitis is rare, particularly following instrumented spine surgery. Candida glabrata presents additional management challenges due to its frequent resistance to azole antifungal treatment and its association with immunocompromised hosts.

A 74-year-old immunosuppressed man underwent L3-4 transforaminal lumbar interbody fusion with cyst excision. Seven weeks postoperatively, he presented with constitutional symptoms and elevated inflammatory markers but was discharged with presumed viral illness. Nine months after surgery, imaging revealed cage displacement. Intraoperative cultures during hardware removal identified C. glabrata. The patient underwent repeat irrigation and debridement with hardware exchange and was treated with intravenous micafungin and oral fluconazole and later transitioned to posaconazole. Despite ongoing antifungal therapy, inflammatory markers remained elevated, and follow-up imaging showed progressive vertebral destruction without hardware failure. The patient continues on chronic antifungal suppression with multidisciplinary monitoring.

This case highlights the diagnostic and therapeutic challenges of postoperative C. glabrata vertebral osteomyelitis. Early suspicion, culture confirmation, and organism-specific antifungal therapy, alongside timely surgical management, are critical to achieving infection control and preserving spinal stability in immunosuppressed patients. https://thejns.org/doi/10.3171/CASE25555.