Vertebral infection with Candida albicans failing caspofungin and fluconazole combination therapy but successfully treated with high dose liposomal amphotericin B and flucytosine

•A Candida osteomyelitis case failing caspofungin+fluconazole treatment is described.•A relapse was diagnosed after ambisome followed by fluconazole therapy.•Prolonged therapy with increasing dose L-AMB and 5-FC eradicated the infection.•Further clinical studies are warranted to define optimal treatment strategies.

A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole. Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.