A rare SARS-CoV-2 complication: Candida spondylodiscitis following SARS-CoV-2 infection-two case reports

Background: In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, opportunistic fungal co-/super-infections have surged globally. This report focuses on Candida spondylodiscitis (CS), an uncommon complication of severe SARS-CoV-2 infection without classical risk factors for invasive candidiasis. Case Description: The first case involved a Hispanic 65-year-old man with severe SARS-CoV-2 infection, developing low-back pain. Magnetic resonance imaging (MRI) and biopsy revealed Candida albicans L4-L5 spondylodiscitis. Initial treatment with fluconazole showed limited improvement; subsequently, liposomal amphotericin and increased fluconazole were administered. Despite treatment adjustments, clinical response was delayed. After a switch to itraconazole, the patient experienced a 17-month antifungal regimen, leading to clinical and radiological improvement. The second case featured an 86-year-old Caucasian man with a history of chronic obstructive pulmonary disease, hypertension, chronic kidney disease, and a recent positive blood culture for Candida tropicalis during severe SARS-CoV-2 infection. An MRI confirmed spondylodiscitis at L3-L4 and L4-L5, and left psoas muscle involvement. Treatment included fluconazole, later interrupted due to worsened liver function tests. Following a regimen with liposomal amphotericin B and fluconazole, the patient exhibited clinical improvement, supported by a positron emission tomographycomputed tomography (PET-CT) showing regression of spondylodiscitis. Conclusions: These cases, unlike previous literature, involved intensive care unit-admitted SARS-CoV-2 patients, emphasizing the need for tailored coronavirus disease 2019 (COVID-19) management. Literature review indicated limited reports of CS in COVID-19 patients. In conclusion, severe SARS-CoV-2 infection creates a conducive environment for fungal proliferation, especially in critically ill patients subjected to various predisposing factors. Fungal aetiology should be considered in spondylodiscitis cases in this patient group.