A Case of Mandibular Osteomyelitis Caused by Geotrichum candidum

Abstract

Geotrichum is a genus of yeast-like fungi of the family Endomycetaceae. It can be isolated from the bronchi, lungs, mouth and the intestinal tract, especially causing invasive disease in immunocompromised patients. Herein, an 61 year old case of mandibular osteomyelitis admitted with swelling on the left cheek and discharge into the mouth and unresponsive to oral antibiotics with Geotrichum candidum growth in tissue culture was reported. He was treated tigecycline and piperacillin/tazobactam empirically without any improvement. G.candidum susceptibility testing revealed low minimum inhibitory concentration values against azole group antifungals. Voriconazole treatment was changed to oral posaconazole due to detection of elevated levels of cholestasis enzyme levels. Clinical and radiological improvement were achieved after four weeks of treatment. The patient died due to necrotizing fasciitis caused by Enterococcus avium in the fourth month of follow-up with antifungal treatment. In osteomyelitis which does not improve with antibiotics, fungi should be considered as an etiological agent.