Candida parapsilosis Infection after Lumbosacral Arthrodesis with a PEEK TLIF Interbody Fusion Device: Case Report

Abstract

Spondylodiscitis is an uncommon but serious complication after spine surgeries, and its main etiologic agent is Staphylococcus aureus . Fungal infections are rare and mostly caused by Candida albicans . We report the clinical case of a 69-year-old male patient who underwent a L2-S1 arthrodesis for degenerative scoliosis correction. He presented an infection 2.5 months after the procedure, a spondylodiscitis at L5-S1 levels, caused by Candida parapsilosis . The treatment consisted of surgical material removal, tricortical iliac graft placement in an anterior approach (L5-S1), lumbopelvic fixation (from T10 to the pelvis) in a posterior approach, and drug treatment with anidulafungin and fluconazole. This last medication was administered for 12 months, with good clinical outcomes.

Keywords: Candida parapsilosis; fungal infections; spondylodiscitis.

Fig. 1

Left sagittal and right axial T2-weighted magnetic resonance images showing an abscess posterior to the L5 vertebral body.

Fig. 2

Left sagittal and right axial computed tomography scans showing signs of S1 pedicle screws loosening, mainly on the right side.

Fig. 3

Sagittal T2-weighted magnetic resonance image showing hypersignal at the L5-S1 disc space referring to the local fluid collection.

Fig. 4

Lateral (left) and front (center) spine radiographs showing signs of arthrodesis (L2-S1 fusion) and sagittal T2-weighted magnetic resonance image (right) showing signs of infection resolution.

Fig. 1

Imagens de ressonância magnética ponderada em T2 (sagital à esquerda e axial à direita) mostrando a presença de abscesso posterior ao corpo vertebral de L5.

Fig. 2

Tomografia computadorizada, corte sagital à esquerda e axial à direita, mostrando sinais de soltura dos parafusos pediculares em S1, principalmente a D.

Fig. 3

Imagem sagital de ressonância magnética ponderada em T2 mostrando hipersinal no espaço discal L5-S1 referente a coleção líquida local.

Fig. 4

Radiografias de coluna vertebral em perfil (esquerda) e de frente (centro), mostrando sinais de artrodese (fusão entre L2 e S1) e imagem de ressonância magnética (direita) ponderada em T2, corte sagital, mostrando sinais de resolução do processo infeccioso.