Case report: Candida krusei spondylitis in an immunocompromised patient

Abstract

Background Invasive infections with Candida krusei are uncommon and rarely complicated by spondylitis. Previous described cases were solely treated with antimycotic therapy, despite guidelines recommending surgical interventions. Case presentation We describe a case of C. krusei spondylitis in a patient treated with chemotherapy for acute myeloid leukemia. After induction chemotherapy, the patient developed a candidemia, which was treated with micafungin. One month after the candidemia, the patient was admitted with severe lumbar pain. Spondylitis of the L4 and L5 vertebra was diagnosed on MR-imaging, with signs suggesting an atypical infection. The patient was treated with anidulafungin combined with voriconazole. Despite maximal conservative management symptoms gradually worsened eventually requiring surgical intervention. Conclusions In contrast to previous case reports, antimycotic treatment alone could be insufficient in treating C. krusei spondylitis.

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

“… back pain Histopathological investigations from intra operative Anterior & Posterior Spinal Debridement, Fusion at L2-3 and drugs caspofungin, fluconazole Injection caspofungin was given for 7 days and patient was discharged with oral fluconazole for 6 months. 6 months 6 months Full recovery Keerthi et al [ 22 ] 56/M Scedosporium apiospermum back pain Histopathological investigations from intra operative D5-11 Segmental Posterior Stabilization, Decompression &Fusion and drugs Voriconazole Voriconazole 200 mg infusion over 2 h twice daily for 5 days, discharged with oral Voriconazole 200 mg twice daily 1 months 1 months diead Gagliano et al [ 23 ] 66/M C. glabrata ward for lumbar pain, progressive difficulty in walking, fever open biopsy of an abscess and culture examination debridement and stabilization of the vertebrae involved and drug anidulafungin anidulafungin 200 mg on the first day, followed by 100 mg daily thereafter unclear unclear Full recovery Overgaauw et al [ 24 ] 78/M C. krusei lower back pain Histopathological investigations from biopsy operative and drugs anidulafungin, voriconazole, amphotericin B anidulafungin (loading dose of 200 mg IV, followed by 100 mg/day IV) oral voriconazole (200 mg/twice daily) amphotericin B (3 mg/kg) 9 months 9 months Improvement Yu et al [ 25 ] 76/M Candida albicans back pain and fever …”

“…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…”