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Case report
peer-reviewed

Lumbar Spinal Candida Glabrata Treated Without Surgical Intervention: A Case Report



Abstract

Candida glabrata is a low virulent commensal fungal organism that, rarely, can cause osteomyelitis. Diagnosis of such an infection is often difficult as the case typically presents with an insidious onset of back pain and minimally elevated biomarkers of inflammation. Furthermore, it is difficult to eradicate and often resistant to common antifungals. 

A 61-year-old man presented with an eight-month history of persistent low back pain which had unsuccessfully been managed by his primary care physician. He had a past surgical history of gastric by-pass complicated by adhesions, ulceration, and perforation with an infection of Candida glabrata that had been treated with intravenous micafungin. Radiological examination showed degenerative changes with suspicion of osteomyelitis and a computerized tomography (CT)-guided biopsy provided tissue samples with subsequent positive cultures for Candida glabrata. The patient was admitted for fungal osteomyelitis with Candida glabrata, treated with intravenous micafungin, and his infection was resolved after six months. At two-year follow-up his back pain has been resolved and no infection was present. In a patient with osteoarticular pain and a previous history of candidal infection with possible candidemia, one should maintain suspicion for fungal osteomyelitis.



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Case report
peer-reviewed

Lumbar Spinal Candida Glabrata Treated Without Surgical Intervention: A Case Report


Author Information

Ryan M. Schiedo

Medical Student, Suny Upstate Medical University, Syracuse, NY

William Lavelle Corresponding Author

Department of Orthopedic Surgery, SUNY Upstate Medical University

Mike H. Sun

Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: William Lavelle declare(s) a grant from DePuy Spine. William Lavelle declare(s) a grant from Medtronic. William Lavelle declare(s) a grant from IntegraLife. William Lavelle declare(s) a grant from Sigmus, Inc. William Lavelle declare(s) a grant from K2M, Inc. William Lavelle declare(s) a grant from Spinal Kinetics, Inc. William Lavelle declare(s) a grant from Providence Technologies. William Lavelle declare(s) a grant from Stryker Spine. William Lavelle declare(s) a grant from Vertebral Technologies, Inc.


Case report
peer-reviewed

Lumbar Spinal Candida Glabrata Treated Without Surgical Intervention: A Case Report


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Case report
peer-reviewed

Lumbar Spinal Candida Glabrata Treated Without Surgical Intervention: A Case Report

  • Author Information
    Ryan M. Schiedo

    Medical Student, Suny Upstate Medical University, Syracuse, NY

    William Lavelle Corresponding Author

    Department of Orthopedic Surgery, SUNY Upstate Medical University

    Mike H. Sun

    Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: William Lavelle declare(s) a grant from DePuy Spine. William Lavelle declare(s) a grant from Medtronic. William Lavelle declare(s) a grant from IntegraLife. William Lavelle declare(s) a grant from Sigmus, Inc. William Lavelle declare(s) a grant from K2M, Inc. William Lavelle declare(s) a grant from Spinal Kinetics, Inc. William Lavelle declare(s) a grant from Providence Technologies. William Lavelle declare(s) a grant from Stryker Spine. William Lavelle declare(s) a grant from Vertebral Technologies, Inc.

    Acknowledgements


    Article Information

    Published: June 20, 2017

    DOI

    10.7759/cureus.1371

    Cite this article as:

    Schiedo R M, Lavelle W, Sun M H (June 20, 2017) Lumbar Spinal Candida Glabrata Treated Without Surgical Intervention: A Case Report . Cureus 9(6): e1371. doi:10.7759/cureus.1371

    Publication history

    Received by Cureus: April 03, 2017
    Peer review began: May 13, 2017
    Peer review concluded: June 06, 2017
    Published: June 20, 2017

    Copyright

    © Copyright 2017
    Schiedo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Candida glabrata is a low virulent commensal fungal organism that, rarely, can cause osteomyelitis. Diagnosis of such an infection is often difficult as the case typically presents with an insidious onset of back pain and minimally elevated biomarkers of inflammation. Furthermore, it is difficult to eradicate and often resistant to common antifungals. 

A 61-year-old man presented with an eight-month history of persistent low back pain which had unsuccessfully been managed by his primary care physician. He had a past surgical history of gastric by-pass complicated by adhesions, ulceration, and perforation with an infection of Candida glabrata that had been treated with intravenous micafungin. Radiological examination showed degenerative changes with suspicion of osteomyelitis and a computerized tomography (CT)-guided biopsy provided tissue samples with subsequent positive cultures for Candida glabrata. The patient was admitted for fungal osteomyelitis with Candida glabrata, treated with intravenous micafungin, and his infection was resolved after six months. At two-year follow-up his back pain has been resolved and no infection was present. In a patient with osteoarticular pain and a previous history of candidal infection with possible candidemia, one should maintain suspicion for fungal osteomyelitis.



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Create a free account to continue reading this article.

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Ryan M. Schiedo

Medical Student, Suny Upstate Medical University, Syracuse, NY

William Lavelle

Department of Orthopedic Surgery, SUNY Upstate Medical University

For correspondence:
lavellwf@yahoo.com

Mike H. Sun

Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY

Ryan M. Schiedo

Medical Student, Suny Upstate Medical University, Syracuse, NY

William Lavelle

Department of Orthopedic Surgery, SUNY Upstate Medical University

For correspondence:
lavellwf@yahoo.com

Mike H. Sun

Department of Orthopedic Surgery, Suny Upstate Medical University, Syracuse, NY