Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature.

Surg Neurol Int. 2019 Aug 2;10:151. doi: 10.25259/SNI_240_2019. eCollection 2019.

Huang S, Kappel AD, Peterson C, Chamiraju P, Rajah GB, Moisi MD.

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Abstract

BACKGROUND:

Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis.

CASE DESCRIPTION:

A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew Candida albicans. Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew C. albicans. The patient was treated with intravenous micafungin for 14 days followed by 6-12 months of 400 mg oral fluconazole daily.

CONCLUSION:

There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.

KEYWORDS:

Candida albicans; Cervical spine; Discitis; Osteomyelitis; Spondylodiscitis

Figure 1:

Sagittal (a) computed tomography without contrast, axial T1 magnetic resonance imaging w/contrast (b) and sagittal T1 magnetic resonance imaging without (c) and with (d) contrast demonstrate an enhancing erosive lesion involving the C6 and C7 vertebral bodies with peripherally enhancing fluid collection within the intervertebral disc space and a large fluid collection along the posterior aspect of the vertebral bodies with compression of the ventral spinal cord at C6-C7. There is also extensive prevertebral swelling with anterior and posterior epidural enhancement extending from C4 to T1.

Figure 2:

Postoperative cervical X-rays anterior-posterior (a) and lateral (b) show placement of C6-C7 expandable cervical cage and C5 to T1 anterior discectomy with instrumentation and fusion, as well as posterior C4 to T2 instrumentation and fusion with C6 and C7 laminectomy. There is restoration of normal anatomic height with interval improvement in alignment of the cervical spine and reduction of the preoperative kyphotic deformity.