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Hematogenous Candida spondylitis. A case report.

S Pohjola-Sintonen, P Ruutu, K Tallroth

    Acta Medica Scandinavica
    |January 1, 1984
    PubMed
    Summary
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    A patient with systemic lupus erythematosus (SLE) and neutropenia developed a rare fungal infection of the lumbar spine. Treatment with oral ketoconazole and clindamycin proved effective after initial intravenous therapy failed.

    Area of Science:

    • Mycology
    • Infectious Diseases
    • Rheumatology

    Background:

    • Systemic lupus erythematosus (SLE) can cause neutropenia, increasing susceptibility to opportunistic infections.
    • Spondylitis, an inflammation of the spine, can be caused by fungal pathogens, particularly in immunocompromised individuals.
    • Candida albicans is a common opportunistic fungus that can cause invasive infections.

    Observation:

    • A 58-year-old patient with SLE-induced neutropenia presented with lumbar spondylitis.
    • The spondylitis was attributed to Candida albicans, with a suspected secondary Staphylococcus aureus superinfection.
    • Initial intravenous therapy with amphotericin B and flucytosine was discontinued due to adverse reactions and lack of efficacy.

    Findings:

    • Subsequent treatment with oral ketoconazole and clindamycin for four months yielded positive clinical outcomes.

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  • The patient experienced no significant side effects during the oral therapy regimen.
  • This case highlights the potential for Candida albicans to cause spondylitis in neutropenic SLE patients.

    • Implications:

    • Oral antifungal and antibiotic combinations may be a viable alternative treatment for invasive Candida infections in specific patient populations.
    • Further research is needed to establish optimal treatment protocols for non-albicans Candida spondylitis in immunocompromised patients.
    • This case underscores the importance of considering opportunistic fungal infections in the differential diagnosis of spondylitis in patients with SLE and neutropenia.