Magano Rita, Cortez Joana, Ramos Evelise, Trindade Luís
Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal.
Clinica Vida Cligeste, Luanda, Angola.
BMJ Case Rep. 2015 Oct 16;2015:bcr2015211327. doi: 10.1136/bcr-2015-211327.
Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.
白色念珠菌骨髓炎是一种罕见疾病，发生于免疫功能低下个体，有时因症状与念珠菌血症不匹配导致诊断延迟。本病例为一名36岁男性患者，有贲门失弛缓症食管手术史，随后多次手术，并因食管瘘并发症入住重症监护病房。出院4个月后，患者因左侧第10 - 12肋疼痛、第4 - 6肋软骨肿胀及视力下降入住感染科。磁共振成像（MRI）检查显示增厚及弥漫性强化，软骨和肋骨边界不清，符合感染表现。经CT引导下骨活检，检测到对抗真菌药物敏感的白色念珠菌。患者开始使用脂质体两性霉素B治疗，并持续使用氟康唑6个月，在此期间临床及影像学表现均有改善。
