Candida parapsilosis spondylodiscitis after lumbar discectomy

Abstract

Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.

Keywords: Candida; Fungal infection; Osteomyelitis; Spondylodiscitis; Vertebra.

Fig. 1

Magnetic resonance image (MRI) showing candidal spondylodiscitis. A : Preoperative sagittal T2-weighted. B : Gadolinium-enhanced T1-weighted MRI showing an increased signal in the inferior and posterior parts of the L5 vertebral body and superior parts of the sacrum. Posterior abscess formation is seen without significant involvement of the adjacent discs.

Fig. 2

Follow-up sagittal T2-weighted (A) and gadolinium-enhanced T1-weighted image (B) showing a marked decrease of the enhanced lesion and epidural abscess 4 month after surgery.