Rationale: Postoperative Candida albicans infections are exceedingly rare in urban populations, especially among patients on long-term immunosuppressive therapy. To date, there have been no reported cases of rheumatoid arthritis (RA) patients developing C albicans infections following spinal surgery. This report aims to highlight this rare occurrence and share insights on management strategies. Patient concerns: A 53-year-old Han Chinese male patient was admitted with severe pain in the right lower limb. He had a 3-year history of RA and was on continuous antirheumatic medication. The postoperative course was complicated by the development of a C albicans infection, which was confirmed after multiple diagnostic measures. Diagnoses: The patient was diagnosed with postoperative C albicans infection based on intraoperative sampling and laboratory confirmation 79 days after spinal surgery. Interventions: The patient underwent targeted antifungal therapy, including an 8-week intravenous course followed by a 3-month oral itraconazole regimen. Supportive measures included meticulous perioperative management, nutritional support, and physical rehabilitation. Outcomes: The infection was successfully controlled, leading to the complete resolution of symptoms. The patient achieved a clinical cure, demonstrating the efficacy of combined antifungal therapy and comprehensive perioperative care. Lessons: This case underscores the importance of vigilant perioperative management in RA patients, especially those with immunosuppression. Individualized treatment strategies, close monitoring of nutritional and functional status, and timely antifungal intervention are essential for preventing and managing such rare infections. Furthermore, a review of literature since 1980 has enhanced our understanding of risk factors, diagnosis, and treatment of postoperative C albicans infections, informing better clinical practice.