American Journal of Medical Case Reports, 2016, Vol. 4, No. 5, 168-169 Available online at http://pubs.sciepub.com/ajmcr/4/5/6 © Science and Education Publishing DOI:10.12691/ajmcr-4-5-6 Vertebral Osteomyleitis Caused by Candida Albicans in an IV Drug Abuser Nagadarshini Ramagiri Vinod, Hassan Tahir * , Khandakar Hussain, Saad Ullah Department of Internal Medicine, Temple University/Conemaugh Memorial Hospital, 1086 Franklin Street, Johnstown, PA 15905, USA *Corresponding author: htahir@conemaugh.org Abstract The incidence of back pain is listed only second to upper respiratory tract infection in symptomatic reason for office visits for a physician. Diagnosing rare and serious causes of back pain may be challenging in outpatient setting. We present a 31 year old male, an IV drug abuser, presenting with severe back pain radiating to his bilateral hips due to L1-L2 Osteomylelitis secondary to Candida Albicans infection. Keywords: candidial vertebral osteomyelitis, back pain Cite This Article: Nagadarshini Ramagiri Vinod, Hassan Tahir, Khandakar Hussain, and Saad Ullah, “Vertebral Osteomyleitis Caused by Candida Albicans in an IV Drug Abuser.” American Journal of Medical Case Reports, vol. 4, no. 5 (2016): 168-169. doi: 10.12691/ajmcr-4-5-6. 1. Introduction Back pain is the most common complaint by patients in outpatient set up. The challenge for clinicians is to identify the fewer patients with a significant probability of a more serious problem that requires further workup. Spondylodiscitis is a relatively unsual disease accounting for 2–7% of all cases of pyogenic osteomyelitis, with incidence varying from 1 per 100,000/year to 1 per 250,000/year [1]. The mean age for the disease incidence is 50 years, and the lower thoracic or lumbar spine is involved in 95% of patients [2]. Here we present one such challenging case who presented to us as lower back pain. 2. Case Presentation A 31 year old male with history of drug abuse presented to emergency department with lower back pain for a month which had worsened for last 2 days. He had prviously presented to clinic for back pain, X ray lumbar spine was ordered at that time which was normal. He was prescribed painkillers and flexeril. This time back pain got worst and he developed severe lower extremity weakness. On examination there was mild tenderness at L1-L2 with no redness or warmth. Neurological examination showed power 4/5 in both extremities and areflexia but no sensory loss. MRI of the spine was performed,which showed discitis and osteomyelitis at L1-L2 with destructive endplate changes including phlegmonous change extending along the anterior cortex of L1-L2 and involving the right psoas muscle with myositis [Figure 1, Figure 2]. An approximate of 4ml of fluid was aspirated from the L1-L2 vertebra, and patient was empirically treated with I.V vancomycin. The Drained fluid was sent for culture and sensitivity which was reported positive for Yeast. Empiric treatment for Candida with I.V Micofungin 100mg daily was started. Once the final fungal culture showed Candideal Albicans growth, a loading dose of Oral Fluconazole 800 mg was given and patient was discharged home on maintenance dose of 400mg daily to be continued for 6. His symptoms continued to improve in next couple of weeks. HIV testing was also done which came back negative. Figure 1. MRI spine showing L1- L2 Osteomylelitis