Case report: Candida krusei spondylitis in an immunocompromised patient
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CASE REPORT
Open Access
Case report: Candida krusei spondylitis in an immunocompromised patient Audrey J. C. Overgaauw1* , David C. de Leeuw2, Susanne P. Stoof3, Karin van Dijk3, Joost C. J. Bot4 and Eef J. Hendriks4
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. Keywords: Candidemia, Candida krusei, Spondylitis
Background Candida spondylitis is an uncommon condition and in most cases due to an infection with Candida albicans [1, 2]. Candida krusei as a causative agent is rare and only two cases have been reported so far, exclusively in immunocompromised patients [3, 4]. Risk factors for an invasive candida infection are an immunocompromised status, enteric surgery and previous candidemia [3–5]. The previously described cases of C. krusei spondylitis were treated with combined antimycotic treatment, although surgical intervention is recommended on indication by the Infectious Diseases Society of America (IDSA) guideline [3, 4, 6]. We describe the first case of C. krusei spondylitis in a patient with acute myeloid leukemia, treated with combined antimycotic and surgical intervention. * Correspondence: [email protected] 1 Department of Internal Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands Full list of author information is available at the end of the article
Case presentation A 78-year-old man presented at the emergency department with increasingly disabling lower back pain. His past medical history revealed transurethral resection of the prostate and lumbar spinal stenosis. In addition, he was recently diagnosed with acute myeloid leukemia for which he received induction chemotherapy 1 month earlier. During this course, he developed a perforated diverticulitis for which he underwent resection of the sigmoid. Subsequently, he developed a candidemia with C. krusei and micafungin treatment was started. Since ophthalmoscopy, echocardiography and ultrasound of the liver did not reveal any signs of septic foci, micafungin was continued until 14 days after the last positive blood culture. After the first cycle of chemotherapy a complete remission
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