Candida sake as the causative agent of spondylodiscitis in a hemodialysis patient

BACKGROUND CONTEXT: Fungal spondylodiscitis is often because of Candida albicans or other common Candida species, whereas unusual strains such as Candida sake are often thought to be nonpathogenic. PURPOSE: To report the first case of spondylodiscitis caused by C sake and its outcome after antimycotic therapy; as the disease occurred in a patient undergoing hemodialysis (HD), we also discuss the potential conditions related to the uremic state and to HD itself, which may predispose to spondylodiscitis. STUDY DESIGN/SETTING: Case report. METHODS: Report of the patient's clinical findings and review of the literature concerning spondylodiscitis in HD patients and infections caused by C sake. RESULTS: The patient was a 48-year-old woman with end-stage renal disease (ESRD) undergoing HD who presented with back pain; spine computed tomographic (CT) scans showed lumbar spondylodiscitis with large bilateral abscesses in the psoas muscles, with an imaging appearance resembling that of Pott's disease. Surprisingly, C sake was isolated from the cultures of the liquid obtained by CT-guided aspiration of both abscesses, and fluconazole therapy was strikingly effective in inducing abscess regression and healing of spondylodiscitis. CONCLUSIONS: In patients with chronic disorders such as ESRD, spondylodiscitis can also be caused by rare fungal strains that are usually thought to be nonpathogenic; a correct diagnostic workup is essential, as such forms can promptly respond to common antimycotic agents.