# Candida Spondylodiscitis After Transforaminal Epidural Steroid Injection: A Case Report

## TL;DR

A 76-year-old man developed a rare fungal spinal infection after a common back injection, highlighting the need for early diagnosis and surgery.

## Contribution

This is one of the first documented cases of Candida albicans spondylodiscitis following a transforaminal epidural steroid injection in an immunocompetent patient.

## Key findings

- Candida albicans was identified as the causative agent of spondylodiscitis after transforaminal epidural steroid injection.
- Intraoperative disc cultures confirmed the fungal infection when other diagnostic methods failed.
- Neurological improvement occurred after discontinuing antibiotics and starting fluconazole treatment.

## Abstract

Transforaminal epidural steroid injection (TFESI) is a widely used intervention for lumbar radicular pain. Although rare, fungal spinal infections can follow such procedures and require prompt diagnosis and management. A 76‑year‑old male developed progressive back pain and bilateral leg weakness two weeks after bilateral L5 TFESI. He received empirical antibiotic therapy in an outside emergency department, but showed no progress. He subsequently presented to our outpatient clinic 11 weeks after TFESI. MRI showed pyogenic spondylitis and osteomyelitis at L1-L2 with psoas involvement. No pathogen was identified in diagnostic evaluations, including acid-fast bacillus (AFB) staining of blood and sputum, blood cultures, urine culture, microorganism identification tests, and bone biopsy cultures. Worsening motor weakness prompted L1-2 decompression; intraoperative disc cultures grew Candida albicans. After discontinuation of empirical antibiotics and initiation of intravenous fluconazole, his neurological status improved; beginning the day after surgery, his lower limb motor strength increased from grade 2 to grade 4, and he was discharged to a rehabilitation facility with motor strength of 4. This case underscores the need for early microbiological diagnosis and surgical biopsy in post‑procedural spinal infections unresponsive to empirical antibiotics. Clinicians should consider fungal etiologies, especially in elderly or oncologic patients. To the best of our knowledge, this represents one of the first documented cases of C. albicans spondylodiscitis following TFESI in an immunocompetent patient.