Salvage Therapy with Rezafungin for Candida parapsilosis Spondylodiscitis: A Case Report from Expanded Access Program

TL;DR

A 68-year-old patient with a rare fungal infection in the spine was successfully treated with rezafungin after other treatments failed.

Contribution

This is the first reported case of rezafungin successfully treating Candida parapsilosis spondylodiscitis with azole resistance.

Findings

Rezafungin provided a full clinical, radiologic, and biochemical response in a patient with Candida parapsilosis spondylodiscitis.

The treatment was well-tolerated with no adverse effects over 26 weeks of weekly 200 mg doses.

Rezafungin may be a promising alternative when first-line antifungal therapies are ineffective or poorly tolerated.

Abstract

Candida spp. spondylodiscitis is a rare condition for which treatment options are often limited. A further obstacle is the duration of therapy, which should be administered for up to twelve months. In view of the long duration of therapy, azoles are, so far, the only oral treatment strategy that can be given as home therapy. In the case of resistance or reduced susceptibility to azoles, there are not enough comfortable treatment opportunities with adequate bone penetration and limited toxicity. We report the first case of the successful use of rezafungin for spondylodiscitis due to Candida parapsilosis with reduced susceptibility to azoles. A 68-year-old patient, affected by paraplegia and short bowel syndrome, was diagnosed with Candida parapsilosis spondylodiscitis, confirmed with a culture on vertebral biopsy after an 18-FDG PET/CT scan. He received 200 mg of rezafungin weekly for 26 weeks, after 10 weeks of previous antifungal treatment that was not well tolerated with voriconazole plus liposomal amphotericin B. He had a full clinical, radiologic, and biochemical response to the therapy with rezafungin, with no adverse effects. Rezafungin can be a promising therapy for Candida osteomyelitis, especially when first line therapies are ineffective, poorly tolerated, or contraindicated.

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