Intradural Candida Albicans infection that presented as epidural abscess: A case report

• Published in: International journal of surgery case reports 2023-06, Vol.107, p.108337, Article 108337
• Main Authors: Lucasti, Christopher, Scott, Maxwell M., Vallee, Emily K., Kowalski, Joseph
• Format: Article
• Language: English
• Subjects: Case Report; Epidural presentation; Intradural infection
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108337

Intradural Candida Albicans infections are rare with limited number of reports on the pathological condition. Among these reports, patients with these infections had radiographic evidence supporting an intradural infection diagnosis. In this case, the patient displayed radiographic imaging suggestive of an epidural infection, but surgery revealed the infection to be intradural. This case exemplifies the importance of considering intradural infections in future cases of suspected epidural abscesses and highlights antibiotic management of intradural C. albicans infections. A incarcerated 26-year-old male presented with a rare Candida Albicans infection. He arrived at the hospital unable to walk, and radiographic imaging was consistent with a thoracic epidural abscess. Due to his severe neurologic deficit and spreading edema, surgical intervention was required and revealed no signs of epidural infection. Incision of the dura revealed a purulent material cultured as C. albicans. After six weeks, the intradural infection returned and the patient required another surgery. This operation helped prevent further motor function loss. When patients present with a progressive neurologic deficit and radiographic evidence indicative of an epidural abscess, it is important for surgeons to be mindful of a possible intradural infection. If no abscess is found in the epidural space during surgery, opening the dura in patients with worsening neurologic symptoms must be considered to rule out an intradural infection. Preoperative suspicion of an epidural abscess can differ from intraoperative diagnosis and looking intradural for an infection can prevent further motor loss. •A perplexing and rare spinal C. albicans infection posed a diagnostic challenge, as preoperative imaging differed from intraoperative findings.•Surgeons must be proactive in spine cases to address potential rapid neurological decline. Dural incisions may be necessary in rare spinal C. albicans infection cases.•Swift intervention with amphotericin B is crucial for spinal C. albicans infections, especially if fluconazole fails to yield significant improvement.