FUNGAL AND TUBERCULOUS SPONDYLODISCITIS IN AN IMMUNOCOMPETENT PATIENT.
AHMAD ARIEFF ATAN1, IRDA YUHANIS AHMAD ZAIDI2, MOHAMMAD AZMY HAMRON3, MUSTAQIM AFIFI3, NAVEEN VIJAYASINGHAM3
1DEPARTMENT OF ORTHOPAEDIC, AND 2DEPARTMENT OF PATHOLOGY, HOSPITAL TUANKU JAAFAR, SEREMBAN, NEGERI SEMBILAN, MALAYSIA, AND 3DEPARTMENT OF ORTHOPAEDIC, HOSPITAL TAWAU, TAWAU, SABAH, MALAYSIA.
Co-infection of both fungal and tuberculous organisms is rare, especially in an immunocompetent patient. We reported here a previously-healthy 66 years old male who presented with severe backpain and weakness of both lower limbs. Subsequent radiological imaging confirmed presence of paravertebral abscess with collapse of T11 vertebra. He was successfully managed with surgical debridement, posterior decompression and stabilisation of thoracolumbar spine. Biopsy and intraoperative culture yielded growth of both Candida albicans and Mycobacterium tuberculosis. Post-operatively he underwent treatment with a combination of anti-tuberculous (rifampicin, isoniazid, ethambutol and pyrazinamide) regime and oral fluconazole. He completed the anti-tuberculous therapy and has recovered to ambulating with walking frame. Despite its rarity, fungal and tuberculous co-infection of the spine should be managed by prioritising medical therapy and combining with surgery whenever it is indicated. Early diagnosis and commencement of treatment have shown to correlate with good outcomes.
Keywords: Co-Infection, Candida Albicans, Mycobacterium Tuberculosis, Spine, infection
Correspondence: DR. AHMAD ARIEFF BIN ATAN, DEPARTMENT OF ORTHOPAEDIC, HOSPITAL TUANKU JAAFAR, JALAN RASAH, 70300 SEREMBAN, NEGERI SEMBILAN, MALAYSIA.
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Brunei Int Med J. 2019;15:118-122