Occult Candida tropicalis spondylodiscitis following severe polytrauma: A case report and literature review

Candida tropicalis spondylodiscitis is a rare invasive fungal infection that is easily overlooked because of its indolent course, nonspecific manifestations, and frequent coexistence with bacterial infection. We report an occult case following severe polytrauma and prolonged intensive care unit stay, with a review of published cases. A 60-year-old man sustained severe polytrauma after a motor vehicle accident, complicated by septic shock, respiratory failure, acute kidney injury, pulmonary infection, and bloodstream infection. After resuscitation, organ support, and antimicrobial therapy, his hemodynamic and respiratory status improved, and bacterial infection-related markers decreased. However, persistent low-grade fever and sustained serum (1,3)-β-D-glucan elevation remained unexplained despite repeated evaluation for common infectious and noninfectious causes. Serial spinal magnetic resonance imaging and ^18F-FDG positron emission tomography/computed tomography revealed progressive thoracolumbar vertebral destruction with increased metabolic activity. The patient later developed lower-limb weakness and sensory deficits due to spinal cord compression. Thoracoscopic spinal debridement was performed, and both metagenomic next-generation sequencing and tissue culture identified C. tropicalis . After prolonged amphotericin B therapy and rehabilitation, infection was controlled, and full motor recovery was achieved at 12-month follow-up. Twenty-four published patients from 20 reports were identified. Most had predisposing backgrounds, including prior invasive candidiasis, broad-spectrum antibiotic exposure, chemotherapy-related immunosuppression, or previous spinal/orthopedic procedures. Diagnosis was often delayed. All patients received antifungal therapy, and surgery was frequently performed for structural, neurological, or diagnostic indications. In conclusion, in high-risk patients with persistent fever, unexplained fungal biomarkers, or delayed neurological symptoms after apparent bacterial control, vertebral infection should be considered as a potential deep-seated fungal focus. Serial imaging, tissue-based microbiological confirmation, individualized antifungal therapy, timely source control when indicated, and long-term follow-up are central to management.