CANDIDA-ALBICANS VERTEBRAL OSTEOMYELITIS TREATED SUCCESSFULLY WITH FLUCONAZOLE

Candida vertebral osteomyelitis, although still rare, has been on the increase over the last decade. In most cases it is a complication of c andidemia, sometimes occurring very late, but it can also result from direct inoculation through trauma or surgery. We describe two cases of Candida vertebral osteomyelitis. Both occurred in intravenous drug us ers with no other site of involvement and no history of candidemia. Ne ither patient was infected by human immunodeficiency virus. The microb iological diagnosis was based on culture of needle biopsy material obt ained under computed tomographic guidance. Candida albicans was the on ly isolate in both cases. The patients were immediately treated with o ral fluconazole monotherapy, started at a dose of 400 mg/d. The same d ose was pursued for three months in the first case, while the second p atient received 400 mg/d for a week, followed by 200 mg/d for 7 weeks. Both patients recovered, and neither relapsed after a follow-up after end of treatment of 6 and 8 months, respectively. Few cases of Candid a vertebral osteomyelitis have been described in the literature. Most reports were associated with a prior phase of candidemia. The longest period between the acute episode and vertebral osteomyelitis is 14 mon ths. Cases in drug addicts are due to intravenous inoculation of yeast s contaminating either the drug itself or the lemon juice sometimes us ed as diluent. The clinical manifestations of Candida vertebral osteom yelitis are the same as those of bacterial vertebral osteomyelitis. Th e lumbar vertebrae are the usual site of involvement. Computed tomogra phic or magnetic resonance imaging confirms the diagnosis of disc infe ction. The etiologic diagnosis is based on isolation of Candida sp. by needle biopsy of the disc. Serologic tests can be contributory both t o the diagnosis and to the assessment of therapeutic efficacy. Amphote ricin B is generally the first-line therapy, alone or in combination w ith flucytosine. Some authors have successfully used fluconazole monot herapy, as in the two cases we report. Although most cases of vertebra l osteomyelitis are due to staphylococci, a fungal pathogen must alway s be borne in mind, especially in drug addicts and patients with a his tory of candidemia, even a long time previously. Microbiological tests should always include fungal cultures.