A Case of Mandibular Osteomyelitis Caused by Geotrichum candidum

Abstract

Geotrichum is a genus of yeast-like fungi of the family Endomycetaceae. It can be isolated from the bronchi, lungs, mouth and the intestinal tract, especially causing invasive disease in immunocompromised patients. Herein, an 61 year old case of mandibular osteomyelitis admitted with swelling on the left cheek and discharge into the mouth and unresponsive to oral antibiotics with Geotrichum candidum growth in tissue culture was reported. He was treated tigecycline and piperacillin/tazobactam empirically without any improvement. G.candidum susceptibility testing revealed low minimum inhibitory concentration values against azole group antifungals. Voriconazole treatment was changed to oral posaconazole due to detection of elevated levels of cholestasis enzyme levels. Clinical and radiological improvement were achieved after four weeks of treatment. The patient died due to necrotizing fasciitis caused by Enterococcus avium in the fourth month of follow-up with antifungal treatment. In osteomyelitis which does not improve with antibiotics, fungi should be considered as an etiological agent.

Keywords

• Geotrichum candidum
• osteomyelitis
• posaconazole
• voriconazole

Geotrichum candidum’un Sebep Olduğu Bir Mandibular Osteomiyelit Olgusu†

Abstract

Geotrichum maya benzeri bir mantar olup Endomycetaceae ailesinde yer almaktadır. Bronş, akciğer, ağız ve bağırsaklardan izole edilebilir, özellikle immün sistemi baskılanmış hastalarda invaziv hastalık yapabilir. Bu yazıda, 61 yaşında yanakta şişlik ve ağız içine akıntı şikayetleriyle başvuran, oral antibiyotikler ile yanıt sağlanamayan, doku örneğinde Geotrichum candidum üreyen bir mandibular osteomiyelit olgusu bildirilmiştir. Olgu ampirik tigesiklin ve piperasilin/tazobaktam almış ancak yarar görmemiştir. Doku kültüründe üreyen G.candidum’un duyarlılık testinde azol grubu antifungallere düşük minimum inhibitör konsantrasyon değerleri saptanmıştır. Vorikonazol başlanan hastada kolestaz enzim seviyelerinin artması nedeniyle, tedavi per oral posakonazol olarak değiştirilmiştir. Tedavinin dördüncü hafta kontrolünde klinik ve radyolojik iyileşme sağlanmıştır. Antifungal tedavi ile izleminin dördüncü ayında Enterococcus avium’a bağlı olarak gelişen nekrotizan fasiit nedeniyle kaybedilmiştir. Antibiyotiklerle düzelmeyen osteomiyelitlerde, mantarlar etken olarak düşünülmelidir.

Keywords

• Geotrichum candidum
• osteomiyelit
• posakonazol
• vorikonazol

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