Chronic skull osteomyelitis due to Cryptococcus neoformans: first case report in an HIV-infected patient

Adiwardana, Natanael Sutikno; Morás, Juliana de Angelo; Bernardo, Leandro Lombo; Klautau, Giselle Burlamaqui; Queiroz, Wladimir; Vidal, José Ernesto

doi:10.1016/j.bjid.2018.11.004

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…The confirmative diagnosis of cryptococcal osteomyelitis relies on positive culture and histological examination of the infective lesion specimens [ 6 , 7 , 21 ]. Hence, obtaining the infective lesion specimen is critical for diagnosis [ 15 , 24 , 27 ]. It is easy to accomplish this in a superficial lesion or ruptured abscess, but not in spine cryptococcal osteomyelitis cases where lesions are usually deep, and the abscess rarely ruptures outwards [ 15 , 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, nonsurgical treatment has also successfully cured some cases [ 13 , 18 , 25 ]. Some clinicians believe that only surgical debridement combined with antifungal treatment can achieve excellent therapeutic effect, and delayed surgery may result in a poor prognosis [ 6 , 27 ]. Ruan et al [ 24 ] and Adsul et al [ 1 ] reported two patients with lower extremity paralysis due to cryptococcal osteomyelitis of the spine.…”

Section: Discussionmentioning

confidence: 99%

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Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

et al. 2023

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Background Cryptococcus neoformans, an opportunistic fungal pathogen, seldom causes infection in immunocompetent people. Cryptococcal osteomyelitis is an uncommon condition in which Cryptococcus invades the bone. It usually occurs as part of a disseminated infection and rarely in isolation. The spine has been reported as the most common site of cryptococcal osteomyelitis; however, isolated case of sacrum involvement in immunocompetent patients has never been reported. Case presentation We report the case of a 37-year-old man without underlying disease who presented with progressive low back and sacrococcygeal pain. The patient was initially diagnosed with sacral tumour by a local doctor, and subsequently, after admission, was diagnosed with sacral tuberculosis. He was empirically treated with antitubercular drugs. The patient failed to respond to antitubercular drugs and complained of worsening low back pain. Additionally, he developed persistent radiating pain and numbness in his legs. For further diagnosis, we performed a computed tomography-guided puncture biopsy of the sacrum, which revealed granulomatous inflammation with massive macrophage infiltration and special staining revealed a fungal infection. We performed sacral debridement and drainage and obtained purulent specimens for pathological examination and microbial culture. Microbial identification and drug susceptibility tests revealed a Cryptococcus neoformans infection sensitive to fluconazole. Postoperatively, the persistent radiating pain and numbness in the legs resolved. After 12 consecutive weeks of antifungal therapy, all his symptoms resolved. The patient remained without any signs of recurrence at the 8-month follow-up. Conclusion We reported a rare case of isolated sacrum cryptococcal osteomyelitis in an immunocompetent patient. Furthermore, we identified and reviewed 18 published cases of spine cryptococcal osteomyelitis. Immunocompetent individuals are also at risk for cryptococcal osteomyelitis. Clinical manifestation and imaging are insufficient to diagnose cryptococcal osteomyelitis of the spine, and invasive examinations, such as puncture biopsy and fungal examinations, are needed. Antifungal therapy yields satisfactory results for the treatment of cryptococcal osteomyelitis of the spine, however, if the infective lesion is large, especially when it compresses the spinal cord and nerves, a regimen combining aggressive surgery with antifungal therapy is indispensable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

et al. 2023

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“… 8 Andrew J. Kobets described a case of a child with a rare early onset STAT5b gain-of-function disease treated with targeted JAK inhibition who developed a cranial Mycobacterium avium osteomyelitis. 9 Natanael Sutikno Adiwardana reported an HIV-infected patient with chronic skull osteomyelitis due to Cryptococcus neoforman s. 10 Simon Nicholson presented 2 patients of osteomyelitis of the skull caused by Aspergillus sp p. 11 …”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Chronic Multifocal Osteomyelitis of the Skull Caused by Klebsiella pneumoniae in Mali

Xu,

Charles,

Ismael

et al. 2023

IDR

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Highly invasive infections caused by Klebsiella pneumonia , which includes bacteremia, liver abscess, meningitis, septic arthritis, and osteomyelitis, in not commonly seen in adult immunocompetent and immunocompromised patients. Here, we report an adult case of chronic multifocal osteomyelitis with severe cranial involvement caused by Klebsiella pneumonia . The patient has a 5-year history of orbital abscess and multiple scalp traumas. CT scan showed right temporal and periorbital osteolysis, multiple parietal osteolysis. The pus was collected twice and routine culture was positive for Klebsiella pneumonia e. Good clinical outcome was achieved with debridement and antibiotic treatment. Microbiologists and clinicians should promptly perform bacteriological cultures on biopsy specimens to facilitate diagnosis when imaging or intraoperative findings of bone infection are suspected, especially in the Mali population.

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“…Radiographic evidence often incurs a delay in the diagnosis as these features usually lag behind the clinical findings by weeks or months[ 19 ]. Specific examinations, including antigen detection, culture and histopathology, are critical for the diagnosis[ 20 ]. There is no consensus on standardized treatment for cryptococcal osteomyelitis although the Infectious Disease Society of America (IDSA) has published guidelines[ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient: A case report

Ma¹,

Liao²,

Wan³

et al. 2022

WJCC

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BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus. As an opportunistic infection, bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease. Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person. The pathogenic fungus often invades vertebrae, femur, tibia, rib, clavicle, pelvis, and humerus, but the ulna is a rare target. CASE SUMMARY A 79-year-old woman complaining of chronic pain, skin ulceration and a sinus on her right forearm was admitted, and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna. Unexpectedly, she was also found to have apparently normal immunity. After treatment with antifungal therapy combined with surgery debridement, the patient’s osteomyelitis healed with a satisfactory outcome. CONCLUSION Although rare, cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients, and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.

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Chronic skull osteomyelitis due to Cryptococcus neoformans: first case report in an HIV-infected patient

Cited by 8 publications

References 4 publications

Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

A Case of Severe Chronic Multifocal Osteomyelitis of the Skull Caused by Klebsiella pneumoniae in Mali

Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient: A case report

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