Candida tropicalis vertebral osteomyelitis: a late sequela of fungemia

Two adult patients who had undergone bone marrow transplantation had transientfungemia due to Candida tropicalis during the posttransplantation neutropenic period and later (at 5 and 14 months post-transplantation) developed vertebral osteomyelitis dueto the same organism. The courses of all adult patients who underwent bone marrow transplantation at our center during this time were reviewed for determining the frequency of this problem. Molecular typing techniques were used to establish the relationship between the organisms isolated during the initial fungemia and those causing the subsequent osteomyelitis. Only two of 532 adults who received transplants at our center from 1980 to 1993 developed candidal osteomyelitis. Moreover, they are part of a subset of 13 patients (2.4% of the total) whose cultures were positive for C. tropicalis; fiveof the13 had fungemia. The study of fungal isolates from prior sites of colonization and fromblood sampled during the original fungemia and of subsequently recovered vertebral boneisolates by means of DNA restriction fragment analysis (with use of standard agarose gel electrophoresis or pulsed-field gel electrophoresis) showed that the colonizing, bloodstream, and bone isolates were identical in each case. Transient C. tropicalis fungemia in severely immunocompromised patients may cause important late infectious complications, including osteomyelitis. Although these initial septic events may appear toresolve easily, the outcome in the two cases in this report suggests that special treatment considerations, such as immediate removal of the central venous catheter and intensive treatment with amphotericin B, may be required in selected cases for prevention oflate sequelae.