脊柱杂志

Fungal Spondylodiscitis: Unexpected Diagnosis, Case Report and Literature Review

Abstract

Alqroom Y. Rami, Michalitsis G. Sotirios, Leue Lukas, Hunger Frank and Franke Jorg

Study design: Case report of a rare case of spondylodiscitis due to Candida species (C. tropicalis).

Objective: To report our case with this rare condition (Fungal spondylodiscitis due to Candida tropicalis) in a 75- year old female immune-competent patient presenting with low back pain and literature review.

Summary of background data: Spondylodiscitis or discitis is an infection in the intervertebral disc space and adjacent end plates, this disease accounts for 2–7% of all cases of pyogenic osteomyelitis, which affects different age groups. There is a wide spectrum of causative agents: pyogenic, granulomatous or parasitic. Nowadays incidence has increased the rise in the prevalence of immunosuppressed patients and intravenous drug abusers, and the increase in spinal surgeries. Nonetheless, the microbiological diagnosis of infectious spondylodiscitis is often difficult to establish and the disease requires prolonged antibiotic treatment in combination with surgical intervention are the cornerstone of management. Candida spondylodiscitis usually affects immunocompromised patients after haematogenous dissemination.

Methods: A 75-year-old female patient, who developed low back pain, pain radiated intermittently to both lower limbs, not associated with any sensorimotor deficit. Imaging of the thoraco-lumbosacral spine at the same day (X-ray, CT and MRI) showed alteration of the inter-vertebral disc in Th11/12 and L1/L2. The patient was treated surgically under general anaesthesia and fluoroscopy control. Results: We successfully treated this patient with spondylodiscitis due to fungal infection. By surgical debridement, fusion and pharmaceutical agents: amphotericin and/or fluconazole. Thoraco-lumbosacral CT, 12 weeks after surgery showed decreased oedema of the vertebra, disc space and pre-spinal soft tissues, the patient was symptom less.

Conclusion: Candidal spondylodiscitis is a rare fungal infection should be suspected in immunocompromised patients and elderly with chronic diseases. Without treatment, the disease is progressive and leads to vertebral destruction and spinal cord and neural Preservation of the structure and function of the spine and pain alleviation. Established pharmaceutical agents are amphotericin and/or fluconazole for a minimum of 3 months and surgical debridement of the disc with instrumented fusion is highly recommended.