(639) A Rare Case of Candida auris Osteomyelitis

Introduction: This case presents Osteomyelitis, a rare complication of diabetic foot ulcers but suspected to be caused by Candida Auris.

Description: A 58-year-old Male with a history of uncontrolled Type 2 Diabetes Mellitus presented with an infected left foot ulcer. He was septic on arrival; tachycardic, febrile and labs revealed anemia, elevated ESR, CRP and a significant leukocytosis. The patient was immediately started on broad-spectrum antibiotics and underwent a partial 1st ray amputation of the left foot. One bone biopsy obtained during the amputation from the 1st and 2nd metatarsals surprisingly grew Candida auris, which was then sent to the state Department of Health for confirmation. After careful deliberation with Infectious Disease consultation services, Micafungin therapy was initiated while waiting for its susceptibility profile and other antibiotics were discontinued. Attempts were made to obtain information from the drug manufacturing company to obtain any data to date on treating OM caused by C. auris but unfortunately were not fruitful. Although, it should be considered, the 1st metatarsal bone biopsy obtained that grew scant C. auris; surgical debridement and best attempts of cleaning the infected, non-viable tissue were performed immediately prior to obtaining satisfactory bone biopsies for culture. Furthermore, surveillance cultures obtained early on in admission were negative for C. auris skin colonization in this patient. After lengthy discussions along with Infectious Disease consultation, the decision was made to treat this patient for OM caused by C. auris for a duration of 6 months, the patient eventually underwent successful tissue graft placement and was subsequently discharged to a rehab facility to recuperate.

Discussion: This case delves into a new era where C. auris could emerge as an unlikely culprit in OM, an already challenging- to -treat infection affecting individuals with uncontrolled diabetes. Special care and notice should be taken to obtain satisfactory cultures to promptly identify causative pathogens preventing delays in initiating appropriate treatment.