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[Candida albicans spondylodiscitis]
J de la Torre Lima1, M E Jiménez-Mejías, J L de Francisco
1Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla.
Abstract:
Infections by Candida sp. have increased notably and cause not only local but also systemic infections. It is rarely mentioned as an etiologic agent of osteomyelitis. Two cases of candidiasic spondylodiscitis are presented with the first being in a 33 year old intravenous drug using male who consulted for mechanical lumbar pain. Spondylodiscitis L2-L3 was observed upon radiological study. Aspiration puncture was carried out and the cultures were negative. Surgical biopsy was performed with spondylodiscitis and an abscess in the spine being observed. C. albicans was isolated in the culture. Pathological study confirmed the diagnosis. Cutaneous and sternocostal involvement was also concommitantly presented. The patient was treated with amphotericin B with a favorable evolution. The second case was in a 35 year old male with burns over 65% of his body due to a laboral accident. Three months after admission the patient presented lumbar pain irradiating to the groin and thigh. Bone destruction of the second lumbar vertebra and an abscess of the right psoas were observed upon CT scan. Puncture biopsy was performed and C. albicans was isolated. Histopathologic study demonstrated osteomyelitis by Candida sp. Treatment with amphotericin B was started. Posteriorly urea and creatinine was raised. Treatment was continued with fluconazole with good therapeutic response.
Insights
Candida sp. infections, though rare, can cause osteomyelitis. This study presents two cases of candidal spondylodiscitis, highlighting successful treatment with antifungal medications like amphotericin B and fluconazole.
Area of Science:
- Mycology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Infections caused by Candida species are increasingly common, leading to both localized and systemic disease.
- Candida species are infrequently recognized as causative agents of osteomyelitis, particularly spinal infections.
Observation:
- Two distinct cases of candidal spondylodiscitis are detailed.
- The first case involved a 33-year-old male intravenous drug user presenting with lumbar pain, later diagnosed with spondylodiscitis L2-L3 and spinal abscess caused by Candida albicans.
Findings:
- The second case presented a 35-year-old male with extensive burns who developed lumbar pain, vertebral destruction, and psoas abscess due to Candida albicans osteomyelitis.
- Both patients were successfully treated with antifungal therapy, with the second patient transitioning from amphotericin B to fluconazole due to renal function changes.
Implications:
- These cases underscore the importance of considering Candida species in the differential diagnosis of spondylodiscitis, especially in immunocompromised or high-risk individuals.
- Effective management involves prompt diagnosis through biopsy and culture, followed by appropriate antifungal treatment, demonstrating the efficacy of amphotericin B and fluconazole.