Candida auris candidemia, septic arthritis, and vertebral osteomyelitis requiring dual antifungal therapy: a case report.

Abstract

Background: Candida auris is a significant cause of severe infections in immunocompromised patients, contributing to its frequent occurrence in healthcare settings. Although Candida species are typically linked to candidemia, deep-seated infections like osteomyelitis have also been observed, though they are rarely documented in literature. A 72-year-old man with Guillain-Barré syndrome (GBS) and quadriplegia, status-post tracheostomy and gastrostomy tube placement, presented with new right facial droop and aphasia. A brain CT was unremarkable. Labs were significant for leukocytosis, anemia, and elevated lactic acid consistent with septic shock. A CT scan of the abdomen and pelvis revealed fluid in both hip joints, concerning for source of infection. Fluid cultures from his left hip grew Candida auris. He was subsequently also diagnosed with Candida auris osteomyelitis and discitis of the thoracic spine, confirmed by PET scan and follow-up fine-needle aspiration. The patient had persistent infection despite treatment with Amphotericin B and micafungin for nine months but has shown clinical and radiographic signs of improvement. A full 12-month course of antifungal therapy is to be completed.

Conclusion: This case underscores the importance of thorough tissue, joint, and vertebral sampling for accurate diagnosis, and highlights the urgent need for standardized treatment protocols for Candida auris osteomyelitis to improve patient outcomes.