{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:41Z","timestamp":1769725961926,"version":"3.49.0"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,24]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Candida<\/jats:italic>\n                      vertebral osteomyelitis is rare, particularly following instrumented spine surgery.\n                      <jats:italic>Candida glabrata<\/jats:italic>\n                      presents additional management challenges due to its frequent resistance to azole antifungal treatment and its association with immunocompromised hosts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A 74-year-old immunosuppressed man underwent L3\u20134 transforaminal lumbar interbody fusion with cyst excision. Seven weeks postoperatively, he presented with constitutional symptoms and elevated inflammatory markers but was discharged with presumed viral illness. Nine months after surgery, imaging revealed cage displacement. Intraoperative cultures during hardware removal identified\n                      <jats:italic>C. glabrata<\/jats:italic>\n                      . The patient underwent repeat irrigation and debridement with hardware exchange and was treated with intravenous micafungin and oral fluconazole and later transitioned to posaconazole. Despite ongoing antifungal therapy, inflammatory markers remained elevated, and follow-up imaging showed progressive vertebral destruction without hardware failure. The patient continues on chronic antifungal suppression with multidisciplinary monitoring.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>\n                      This case highlights the diagnostic and therapeutic challenges of postoperative\n                      <jats:italic>C. glabrata<\/jats:italic>\n                      vertebral osteomyelitis. Early suspicion, culture confirmation, and organism-specific antifungal therapy, alongside timely surgical management, are critical to achieving infection control and preserving spinal stability in immunosuppressed patients.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25555\">https:\/\/thejns.org\/doi\/10.3171\/CASE25555<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25555","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:13:17Z","timestamp":1769685197000},"source":"Crossref","is-referenced-by-count":0,"title":["Candida glabrata vertebral osteomyelitis following L3\u20134 transforaminal lumbar fusion: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7849-7773","authenticated-orcid":true,"given":"Bryce R.","family":"Michael","sequence":"first","affiliation":[{"name":"College of Medicine, University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2099-6350","authenticated-orcid":true,"given":"Adam","family":"Youssef","sequence":"additional","affiliation":[{"name":"Kansas City University School of Medicine, Kansas City, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paige","family":"Grafton","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saleh","family":"Mostafa","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3325-7118","authenticated-orcid":true,"given":"Jonathan","family":"Sayegh","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis A.","family":"Robles","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Banner University Medical Center\/University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abduljabbar","family":"Alhammoud","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Banner University Medical Center\/University of Arizona, Tucson, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"J Fungi (Basel)","first-page":"667","article-title":"Candida glabrata: pathogenicity and resistance mechanisms for adaptation and survival","volume":"7","author":"Hassan","year":"2021","unstructured":"Hassan YChew SYThan LTL.Candida glabrata: pathogenicity and resistance mechanisms for adaptation and survival. J Fungi (Basel). 2021;7(8):667."},{"issue":"2","key":"bib2","series-title":"Antimicrob Agents Chemother","first-page":"668","article-title":"Mechanisms of azole resistance in clinical isolates of Candida glabrata collected during a hospital survey of antifungal resistance","volume":"49","author":"Sanguinetti","year":"2005","unstructured":"Sanguinetti MPosteraro BFiori BRanno STorelli RFadda G.Mechanisms of azole resistance in clinical isolates of Candida glabrata collected during a hospital survey of antifungal resistance. Antimicrob Agents Chemother. 2005;49(2):668-679."},{"issue":"1","key":"bib3","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"135","article-title":"Treatment and outcomes of Candida osteomyelitis: review of 53 cases from the PATH Alliance\u00ae registry","volume":"33","author":"Neofytos","year":"2014","unstructured":"Neofytos DHuprikar SReboli ATreatment and outcomes of Candida osteomyelitis: review of 53 cases from the PATH Alliance\u00ae registry. Eur J Clin Microbiol Infect Dis. 2014;33(1):135-141."},{"issue":"8","key":"bib4","series-title":"Intern Med J","first-page":"828","article-title":"Risk of infections in patients with inflammatory rheumatic diseases receiving biologic therapy: a meta-analysis of randomized controlled trials","volume":"44","author":"Limperg","year":"2014","unstructured":"Limperg TNolte IMKoudstaal T.Risk of infections in patients with inflammatory rheumatic diseases receiving biologic therapy: a meta-analysis of randomized controlled trials. Intern Med J. 2014;44(8):828-837."},{"issue":"8","key":"bib5","series-title":"Antimicrob Agents Chemother","first-page":"e00512","article-title":"Amphotericin B induction with voriconazole consolidation as salvage therapy for FKS-associated echinocandin resistance in Candida glabrata septic arthritis and osteomyelitis","volume":"63","author":"Wright","year":"2019","unstructured":"Wright WFBejou NShields RKMarr KGMcCarty TPPappas PG.Amphotericin B induction with voriconazole consolidation as salvage therapy for FKS-associated echinocandin resistance in Candida glabrata septic arthritis and osteomyelitis. 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