Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: A case report and an updated literature review

Objectives: We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis. Methods: PubMed was searched for cases of Candida osteomyelitis published in the English-language literature between 1970 and 2010. Case: A 60-year-old previously healthy man was hospitalized with gallstone pancreatitis. Between 3 weeks and 6 months after hospitalization, he developed bilateral osteomyelitis of the feet with C. tropicalis and C. krusei. The patient was treated with surgery, fluconazole, and a liposomal formulation of amphotericin B. The left lower limb was amputated, and at a 2-year follow-up, the patient had almost no pain in his right foot. Literature review: We identified 40 new cases in the literature since the latest review in 2004. Most cases of Candida osteomyelitis are caused by Candida albicans, but an increasing number are caused by non-albicans species. The prognosis is favorable, with full recovery in the majority of cases. Conclusions: Candida osteomyelitis should be considered when a patient presents with risk factors and pain without previous trauma, because Candida, despite being part of the normal flora, is the fourth leading cause of hematogenous nosocomial infections. The recommended treatment is surgery and fluconazole as monotherapy or initially combined with a fungicidal agent, either a different amphotericin B formulation or an echinocandin.