Spondilodiscit caused by Candida parapsilosis: case report and literature review

Abstract

Introduction: Fungic Spondilodiscit decorrent of Candida generus species are rare, being less than 75 cases described until 2004. Case Report: Man, 42 years old, with 35 years history of alcohol abuse, was admitted with a lower abdomen pain with irradiation to inferior members and weakness of them in the past 3 months. The physical exam were: gluteus muscular atrophy, mobilization pain of the coxo-femoral articulation, L4 and L5 back pain and muscle strength grade II in the inferior member distal part. The patient was admitted and initiated clindamicin and ciprofloxacin with the suspect of spondilodiscit, confirmed by Magnetic Ressonance (RM). Two weeks latter the patient started a breathing pain. Chest radiography and computadorizated tomography shown a difuse multinodule pulmonary presentation suggestive of fungic infection or atypic tubercular presentation. Biopsy shown a granuloma with central necrosis and the culture Candida albicans. One month of antibioticotherapy there was an improvement of inferior abdomen pain and inferior members therefore without radiologic improvement. Aspirative biopsy of the lumbar mass was made with positive culture for parapsilosis candida, introducing Anfotericin B. Five months after the continuous use of these drug there were pulmonary and lumbar spine radiologic improvement with symptoms remission. Discussion: The abusive use of alcohol constitute a risk factor to the development of spondilodiscit of the Candida generus, considered that theorically improve predisposition for systemic infections by regular low virulency organisms. Conclusion: Spondilodisct caused by Cândida is a rare event, therefore must be suspected in patients with some kind of imunossupression, like severe etilism.