Diagnosis and treatment of nonadjacent cryptococcal infections at the L1 and S1 vertebrae

Abstract

Cryptococcal spine infections are rare infections that are easy to misdiagnose and difficult to cure. Therefore, we report the case of a 25-year-old man who presented with nonspecific spinal lesions at L1 and S1. The patient underwent surgical removal of the lesions, and specimens were submitted for microbial identification, which identified a cryptococcal infection that was susceptible to amphotericin B. The patient exhibited marked improvement after receiving intravenous amphotericin B and remained asymptomatic (no back pain, fever, or other symptoms) at the 3‑ and 9‑month follow-ups. Similar cases of cryptococcal spine infections are rare, and we believe that our diagnostic findings and treatment experience may help improve the management of this rare disease.

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

“…The serum cryptoccocal antigen (-) Isolated The vertebral abscess was drained and aspirated Fluconazole 12 weeks of oral fluconazole 12 weeks 12 months Full recovery Joo et al[ 2 ] 66/F L2 Rectal cancer with adjuvant chemotherapy Metastatic tumor Postoperative pathologic examination. CSF culture and cryptococcal antigen (-) Isolated Corpectomy of L2 vertebral body Amphotericin B Fluconazole 1 week of intravenous amphotericin B and fluconazole, then, 1 year of oral fluconazole 12 months 12 months Full recovery Lai et al [ 20 ] 25/M L1, S1 No Osteosarcoma Preoperative biopsy revealed an infected lesion, postoperative microbial identification revealed cryptococcal infection Disseminated Lumbosacral debridement Amphotericin B 4 weeks of intravenous amphotericin B and then 8 weeks of oral amphotericin B 12 weeks 9 months Full recovery Li et al [ 17 ] 17/F L1 Immune hemolytic anemia Tuberculosis C. neoformans was isolated in CSF cultures. CSF cryptococcus antigen (+), Preoperative specific stains for C. neoformans (+) Isolated Spinal debridement and fusion Fluconazole 3 months of oral fluconazole Unclear 3 months Full recovery Nankeu et al [ 10 ] ...…”

“…We found only three published cases of cryptococcal osteomyelitis involving the sacrum [ 10 , 20 , 21 ]. Lai et al [ 20 ] reported a case of nonadjacent cryptococcal infection involving L1 and S1 vertebrae.…”

“…We found only three published cases of cryptococcal osteomyelitis involving the sacrum [ 10 , 20 , 21 ]. Lai et al [ 20 ] reported a case of nonadjacent cryptococcal infection involving L1 and S1 vertebrae. The other two cases by Nankeu et al and Noh et al reported disseminated cryptococcosis involving the sacrum and the patients had underlying comorbidities [ 10 , 21 ].…”

Criptococosis vertebral. Comunicación de un caso y revisión bibliográfica

“…Nosotros exponemos, de estas referencias, solo los casos con compromiso de columna vertebral. Posterior a la publicación de Medaris, encontramos tres casos más de osteomielitis vertebral que sumamos a la serie [5][6][7] .…”

“…La osteomielitis ocurre en 5-10% de los pacientes con enfermedad criptocóccica diseminada [2][3][4] . Las infecciones criptocóccicas esqueléticas aisladas ocurren con menos frecuencia aun, siendo la afección de la columna vertebral una de las más reportadas 1,2,[5][6][7] .…”