Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review

Carpenter, Kent E.; Etemady-Deylamy, Ali; Costello, Victoria; Khasawneh, Mohammad T.; Chamberland, Robin R.; Tian, Ke; Donlin, Maureen J.; Moreira-Walsh, Brenda; Reisenbichler, Emily; Abate, Getahun

doi:10.3389/fmed.2022.942751

Cited by 6 publications

(3 citation statements)

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“…The authors stated that bony involvement due to Cryptococcus species is uncommon, with an estimated prevalence of 5%, and virtually every bone could be involved. The current review revealed 106 more cases in adults including this present report [ 4 – 8 , 11 – 82 ] (Table 1 ).…”

Section: Review Of the Literaturementioning

confidence: 75%

Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature

et al. 2023

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Introduction Osteomyelitis is a bone inflammation that can be related to various infectious agents. As with any other type of inflammation, the prevailing symptoms and signs may include redness, swelling, pain, and heat. Fungal osteomyelitis is rare and usually found in immune-compromised patients. Case presentation A non-human immunodeficiency virus immunocompromised Greek female patient, 82 years old, visited the emergency department due to a 3 day pain located mainly over the left tibia’s anterior surface, accompanied by swelling and redness. There was also a subcutaneous lesion of her left breast. Medical history revealed that the patient had an unmasked close contact with pigeons, a main host of the disease. Initial x-ray imaging showed an osteolytic area in the upper third of the tibial diaphysis. The patient was admitted and underwent a computed tomography-guided biopsy. The specimen revealed a Cryptococcus neoformans infection of the bone and the breast. She was treated with 400 mg fluconazole twice a day for 3 weeks while in hospital and 200 mg twice a day upon discharge for 9 months. After that, she underwent surgical debridement because of lasting local irritation. She was closely monitored in our outpatient office, and in her last visit, 1 year after the initial admission, inflammatory signs had regressed vastly. Conclusions To our knowledge, this is the ninth cryptococcal osteomyelitis of the tibia to be recorded since 1974, and the most unusual finding was the bifocal nature of the infection, affecting both the tibia and the breast.

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Section: Review Of the Literaturementioning

confidence: 75%

Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature

et al. 2023

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“…Of the total number of patients, the male sex was affected in 48 cases while the median age was 60 years, with statistically significant differences between the two groups: alive versus dead in both variables ( p value = 0.0203 and 0.0332, respectively). Of 60 patients with available information, 31 were from the United States 15 , 16 , 19 – 40 (51.6%), 8 from Peru 41 (13.3%), 7 from Brazil 14 , 42 – 47 (11.6%), and 2 from India 48 , 49 and Italy 50 , 51 (3.3% each), while the rest were from Canada, 52 Colombia, 53 China, 54 the Czech Republic, 55 the UK, 56 Uganda, 57 Qatar, 58 Lebanon, 59 Spain, 60 and Germany 61 ( n = 1; 1.7% each).…”

Section: Resultsmentioning

confidence: 99%

COVID-19 associated with cryptococcosis: a scoping review

Quincho-Lopez,

Poma,

José Montenegro-Idrogo

2024

Therapeutic Advances in Infection

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Background: There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective: To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods: We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that ‘ n’ refers to the total number of individuals with the specified variable. Results: A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53–70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% ( n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion: Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.

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“…After inhalation, Cryptococcus can localize in the lungs and cause cryptococcal pneumonia or disseminate hematogenously, affecting other extrapulmonary infection sites [ 7 ]. Although the lungs and central nervous system are the most commonly affected sites, other organs or tissues may be infected [ 2 , 3 , 8 ]. Occasionally, the skeleton can also be invaded leading to cryptococcal osteomyelitis, which usually results from the hematogenous spread of lung infection [ 3 , 9 ].…”

Section: Introductionmentioning

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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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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Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review

Cited by 6 publications

References 40 publications

Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature

Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature

COVID-19 associated with cryptococcosis: a scoping review

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

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