Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature

Abstract

Background: Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis. Case Description: A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew Candida albicans. Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew C. albicans. The patient was treated with intravenous micafungin for 14 days followed by 6–12 months of 400 mg oral fluconazole daily. Conclusion: There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

“…After reviewing all English language reports of fungal osteomyelitis involving the spine since 2010, a minimum of 40 related cases were identified (Table2). Among them, infections included 19 (47.5%) cases of Candida[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], 10 (25.0%) of Aspergillus[21,22,29,[38][39][40][41][42][43][44], 6 (15%) of Cryptococcus[45][46][47][48][49][50], 2 (5%) cases of Blastomyces[51,52], and 4 (10.0%) cases involving other microorganisms[22,[53][54][55]. M. restricta, an opportunistic fungal pathogen, is implicated in various human skin disorders including tinea versicolor, seborrheic dermatitis/dandruff, atopic dermatitis, folliculitis, and psoriasis…”