Spondylodiskitis due to Candida albicans: Report of two patients who were successfully treated with fluconazole and review of the literature

Abstract

We report the cases of two patients with spondylodiskitis due to Candida albicans who were successfully treated with fluconazole. On the basis of findings from these cases and a review of 52 mycologically proven cases in the literature, we describe the main characteristics of candidal spondylodiskitis. In 60% of the cases, candidal spondylodiskitis was a late complication of candidemia (mean delay, 5.2 months); it was determined to be a complication on the basis of the results of previously positive blood cultures (19 cases), and it was presumed to be a complication in iv drug addicts (12 cases). As spondylodiskitis can be a late complication of candidemia, all episodes of candidemia should be treated with systemic antifungal agents. Clinical and radiological signs of candidal spondylodiskitis were nonspecific. Any bone or joint symptoms in a patient who has had candidemia should be considered to be of fungal origin at the time of presentation. The definitive diagnosis of candidal spondylodiskitis was made on the basis of the results of percutaneous puncture in 26 of 30 cases. The overall prognosis for patients with candidal spondylodiskitis was good, with the full recovery rate ranging from 67% to 100%. The preliminary results of treating candidal spondylodiskitis with triazole derivatives, particularly fluconazole, were satisfactory; there was excellent tolerance of this drug.