Candida Femoral Osteomyelitis in a Young Adult Without Known Risk Factors for Immunosuppression: A Case Report

Fungal osteomyelitis is a rare and challenging infection that typically affects individuals with compromised immune systems. Its insidious presentation often leads to delays in diagnosis and treatment. We report Candida species femoral osteomyelitis in a previously healthy 20-year-old man without known risk factors for immunosuppression who presented with a six-month history of unilateral thigh pain and limping. Laboratory tests, including C-reactive protein (mildly elevated at 10 mg/L) and erythrocyte sedimentation rate (20 mm/hour), were near‑normal. Magnetic resonance imaging (MRI) revealed a lytic lesion in the femoral diaphysis with associated cortical destruction and periosteal reaction. The patient underwent surgical debridement and bone biopsy. Intraoperative cultures grew Candida species, confirmed by histopathology demonstrating inflamed fibrovascular tissue without evidence of malignancy. Treatment consisted of oral ketoconazole 400 mg daily for six months, resulting in complete clinical recovery with radiographic evidence of bone healing at one‑year follow-up. In conclusion, this case underscores the critical need to consider fungal etiologies in the differential diagnosis of subacute osteomyelitis, even in young patients without traditional risk factors. A high index of suspicion, combined with early surgical intervention and targeted antifungal therapy, is paramount for achieving a favorable clinical outcome and preventing long‑term morbidity.