title: Candida lusitaniae discitis after discogram in an immunocompetent patient.
abstract: BACKGROUND
  Discitis or epidural abscess after discogram is a rare but known complication. It is more commonly bacterial; however, fungal discitis has been previously reported in immunocompromised patients. The management of fungal discitis in immunocompetent patients is rarely presented or addressed in the literature.
  
  
  OBJECTIVE
  To present a rare atypical fungal discitis after routine discogram with a typical presentation in an immunocompetent host, review diagnostic and management guidelines for discitis, and provide recommendations for management of atypical discitis in immunocompetent patients.
  
  
  METHODS
  Case report and review of the literature.
  
  
  METHODS
  A 40-year-old woman presented with a 3-week history of progressively worsening low back pain after a lumbar discogram. Magnetic resonance imaging revealed L3-L4 discitis without an epidural abscess. Left L3 and L4 hemilaminectomies with L3-L4 discectomy were performed. An inflammatory mass was seen in the L3-L4 disc space region extending to the left L3 foramen.
  
  
  RESULTS
  Culture specimens obtained during surgery from both the disc and epidural space speciated to Candida lusitaniae. The patient completed a 6-month course of fluconazole therapy. At 2-year follow-up, she continued to be asymptomatic, without any recurrence of infection or neurologic sequelae.
  
  
  CONCLUSIONS
  We report a case of C. lusitaniae spondylodiscitis after discography in an immunocompetent patient with long-term follow-up. Clinicians must maintain a high index of suspicion for discitis in patients who undergo this procedure. If discitis is suspected, culture specimens must be evaluated for fungal and mycobacterial organisms, even in the immunocompetent host. With proper surveillance, surgical intervention, and appropriate postoperative follow-up, this complication can be effectively managed with excellent long-term outcome.
authors: Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt, Charlottesville, VA 22908, USA.
authors: Brian C
authors: BC
authors: Werner
authors: MaCalus V
authors: MV
authors: Hogan
authors: Francis H
authors: FH
authors: Shen
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015299:Discitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D020802:Epidural Abscess / Q000209:etiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D009192:Myelography
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole