Wang Yulei, Feng Fanzhe, Yu Zhongzheng, Liang Jinlong, Xu Yongqing, Zhou Tianhua, Shao Nengqi, Xu Wenhao, Cui Yi
School of Clinical Medicine, Dali University, Dali, China.
Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, Kunming, China.
Medicine (Baltimore). 2025 Jul 25;104(30):e42970. doi: 10.1097/MD.0000000000042970.
Postoperative Candida albicans infections are exceedingly rare in urban populations, especially among patients on long-term immunosuppressive therapy. To date, there have been no reported cases of rheumatoid arthritis (RA) patients developing C albicans infections following spinal surgery. This report aims to highlight this rare occurrence and share insights on management strategies.
A 53-year-old Han Chinese male patient was admitted with severe pain in the right lower limb. He had a 3-year history of RA and was on continuous antirheumatic medication. The postoperative course was complicated by the development of a C albicans infection, which was confirmed after multiple diagnostic measures.
The patient was diagnosed with postoperative C albicans infection based on intraoperative sampling and laboratory confirmation 79 days after spinal surgery.
The patient underwent targeted antifungal therapy, including an 8-week intravenous course followed by a 3-month oral itraconazole regimen. Supportive measures included meticulous perioperative management, nutritional support, and physical rehabilitation.
The infection was successfully controlled, leading to the complete resolution of symptoms. The patient achieved a clinical cure, demonstrating the efficacy of combined antifungal therapy and comprehensive perioperative care.
This case underscores the importance of vigilant perioperative management in RA patients, especially those with immunosuppression. Individualized treatment strategies, close monitoring of nutritional and functional status, and timely antifungal intervention are essential for preventing and managing such rare infections. Furthermore, a review of literature since 1980 has enhanced our understanding of risk factors, diagnosis, and treatment of postoperative C albicans infections, informing better clinical practice.
术后白色念珠菌感染在城市人群中极为罕见，尤其是在长期接受免疫抑制治疗的患者中。迄今为止，尚无类风湿关节炎（RA）患者在脊柱手术后发生白色念珠菌感染的报道。本报告旨在强调这一罕见病例，并分享管理策略方面的见解。
一名53岁的中国汉族男性患者因右下肢剧痛入院。他有3年类风湿关节炎病史，一直在持续服用抗风湿药物。术后病程因发生白色念珠菌感染而复杂化，经过多项诊断措施后得以确诊。
根据术中采样及实验室确认，该患者在脊柱手术后79天被诊断为术后白色念珠菌感染。
患者接受了针对性抗真菌治疗，包括为期8周的静脉用药疗程，随后是为期3个月口服伊曲康唑治疗方案。支持性措施包括精心的围手术期管理、营养支持和身体康复。
感染得到成功控制，症状完全缓解。患者实现了临床治愈，证明了联合抗真菌治疗及全面围手术期护理的有效性。
该病例强调了对类风湿关节炎患者，尤其是免疫抑制患者进行警惕的围手术期管理的重要性。个体化治疗策略、密切监测营养和功能状态以及及时的抗真菌干预对于预防和管理此类罕见感染至关重要。此外，对1980年以来文献的回顾加深了我们对术后白色念珠菌感染的危险因素、诊断和治疗的理解，为更好的临床实践提供了依据。
