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Case Reports in Orthopedics
Volume 2014, Article ID 986393, 6 pages
http://dx.doi.org/10.1155/2014/986393
Case Report

Cervical Bone Graft Candida albicans Osteomyelitis: Management Strategies for an Uncommon Infection

1Department of Neurosurgery, Pope John XXIII Hospital, WHO Square No. 1, 24100 Bergamo, Italy
2Department of Neuroradiology, Pope John XXIII Hospital, WHO Square No. 1, 24100 Bergamo, Italy
3Department of Anaesthesia and Intensive Care, Pope John XXIII Hospital, WHO Square No. 1, 24100 Bergamo, Italy

Received 8 June 2014; Accepted 1 September 2014; Published 10 September 2014

Academic Editor: Mark K Lyons

Copyright © 2014 Carlo Brembilla et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Candida osteomyelitis in the current literature is an emerging infection. The factors contributing to its emergence include a growing population of immunosuppressed patients, invasive surgeries, broad-spectrum antibiotics, injection drug users, and alcohol abuse. The diagnosis requires a high degree of suspicion. The insidious progression of infection and the nonspecificity of laboratory and radiologic findings may contribute to a delay in diagnosis. The current case concerns a 27-year-old man with a spinal cord injury who, after undergoing anterior cervical fixation and fusion surgery, developed postoperative systemic bacterial infection and required long-term antibiotic therapy. After six months, a CT scan demonstrated an almost complete anterior dislocation of the implants caused by massive bone destruction and reabsorption in Candida albicans infection. The patient underwent a second intervention consisting firstly of a posterior approach with C4–C7 fixation and fusion, followed by a second anterior approach with a corpectomy of C5 and C6, a tricortical bone grafting from the iliac crest, and C4–C7 plating. The antifungal therapy with fluconazole was effective without surgical debridement of the bone graft, despite the fact that signs of the bone graft being infected were seen from the first cervical CT scans carried out after one month.