A rare SARS-CoV-2 complication: Candida spondylodiscitis following SARS-CoV-2 infection—two case reports

Alberto Gaviraghi, Davide Vita, Giacomo Stroffolini, Tommaso Lupia, Lucio BOGLIONE

Risultato della ricerca: Contributo su rivistaArticolo in rivistapeer review

Abstract

Background: In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, opportunistic fungal co-/super-infections have surged globally. This report focuses on Candida spondylodiscitis (CS), an uncommon complication of severe SARS-CoV-2 infection without classical risk factors for invasive candidiasis. Case Description: The first case involved a Hispanic 65-year-old man with severe SARS-CoV-2 infection, developing low-back pain. Magnetic resonance imaging (MRI) and biopsy revealed Candida albicans L4–L5 spondylodiscitis. Initial treatment with fluconazole showed limited improvement; subsequently, liposomal amphotericin and increased fluconazole were administered. Despite treatment adjustments, clinical response was delayed. After a switch to itraconazole, the patient experienced a 17-month antifungal regimen, leading to clinical and radiological improvement. The second case featured an 86-year-old Caucasian man with a history of chronic obstructive pulmonary disease, hypertension, chronic kidney disease, and a recent positive blood culture for Candida tropicalis during severe SARS-CoV-2 infection. An MRI confirmed spondylodiscitis at L3–L4 and L4–L5, and left psoas muscle involvement. Treatment included fluconazole, later interrupted due to worsened liver function tests. Following a regimen with liposomal amphotericin B and fluconazole, the patient exhibited clinical improvement, supported by a positron emission tomography-computed tomography (PET-CT) showing regression of spondylodiscitis. Conclusions: These cases, unlike previous literature, involved intensive care unit-admitted SARS-CoV-2 patients, emphasizing the need for tailored coronavirus disease 2019 (COVID-19) management. Literature review indicated limited reports of CS in COVID-19 patients. In conclusion, severe SARS-CoV-2 infection creates a conducive environment for fungal proliferation, especially in critically ill patients subjected to various predisposing factors. Fungal aetiology should be considered in spondylodiscitis cases in this patient group.

Lingua originaleInglese
RivistaJournal of Public Health and Emergency
Volume8
DOI
Stato di pubblicazionePubblicato - 2024

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