Cryptococcal osteomyelitis of the skull in a liver transplant patient

Abstract

Cryptococcus neoformans is an opportunistic fungal pathogen and an important cause of morbidity and mortality in immunocompromised patients. We report a case of osteomyelitis caused by C. neoformans in a liver transplant recipient who presented with a headache and scalp lump after sustaining mild head trauma. There was no evidence of central nervous system involvement or dissemination. This is the first known case report of isolated cryptococcal osteomyelitis in a liver transplant recipient.

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

“…Direct inoculation is an uncommon form of origin of cryptococcal bone disease, with only fourcases described previously in the literature. 1 In our case, a history of direct repetitive trauma and the chronology of clinical manifestations may suggest that skull disease preceded meningeal and bloodstream involvement. Notwithstanding, the possibility that a reactivation of a latent reservoir in a long-standing immunosuppressed HIV patient should also be considered.…”

“…Globally, invasive fungal infections are responsible for a high burden of mortality and morbidity, especially in immunocompromised individuals. 1 Cryptococcosis accounts for up to 200,000 deaths per year and its mortality may reach up to 70% at three months after diagnosis, mainly in sub-Saharan Africa. 2 …”

Cryptococcus neoformansosteomyelitis and intramuscular abscess in a liver transplant patient

“…Although this presentation is consistent in appearance and symptomatology with bacterial osteomyelitis, it is important to also consider opportunistic infections or tuberculosis in immunocompromised populations 2 13. Exposure history is an important consideration to rule out lesions caused by endemic mycoses, including coccidioidomycosis, blastomycosis and histoplasmosis 13. The appearance of a lytic bone lesion on imaging can also suggest a malignant aetiology, particularly in patients with a history of prostate or lung cancer 11 13.…”

Cryptococcus neoformans osteomyelitis of the calcaneus: Case report and literature review

“…Cryptococcus neoformans is an encapsulated, yeast-like fungus that can cause systemic mycosis, particularly in immunocompromised patients (ICP). 1 – 3 After inhalation, the organism may remain localized in the lungs or disseminate hematogenously, causing a systemic fungemia with numerous extrapulmonary infection sites. 4 ICP with sarcoidosis, Hodgkin’s disease, leukemia, and AIDS, and those with long-term use of corticosteroids are predisposed to develop cryptococcosis.…”