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

Abstract

Cryptococcus neoformans is an encapsulated, yeast-like fungus that can cause a systemic mycosis, particularly in immunocompromised patients. Disseminated infections typically affect the central nervous system, and osseous lesions are infrequent. Only 5%–10% of disseminated cryptococcosis involves bones. A 69-year-old female presented pain, swelling, and a soft tissue mass in her right lateral hindfoot. Her medical history included a kidney transplant (10 years earlier) secondary to chronic disease due to IgA nephropathy. The patient underwent an excisional biopsy, surgical debridement, and secondarily negative pressure wound therapy to achieve skin closure. Biopsy revealed a rare Cryptococcus neoformans osteomyelitis of the calcaneus. The patient then received IV treatment with liposomal amphotericin B at 3 mg/kg/d for 25 days. In conclusion, we present a case of cryptococcal osteomyelitis which, although not a frequent disease, must be considered as one of the differential diagnoses of osteolytic osseous lesions in patients with chronic osteomyelitis. Cryptococcus neoformans may be a potential cause of below-knee infection, mainly in immunocompromised patients.

Disseminated Cryptococcosis Involving Skin and Lung in an Immunocompromised Patient After Kidney Transplantation: A Case Report

“…Initially, the patient was diagnosed with pulmonary cryptococcal infection. Subsequently, her cutaneous infection appeared as a manifestation of disseminated cryptococcosis, which has been reported in similar case studies [10][11][12] . Generally, disseminated cryptococcosis can present with various skin manifestations, including not only abscesses and nodules but also ulcers, vesicles, granulomas, purpura, pustules, and even draining sinuses and cellulitis.…”

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

“…Common clinical manifestations of spine cryptococcal osteomyelitis include local pain, tenderness, and oedema, sometimes accompanied by fever, weakness, and other manifestations of spinal cord compression [ 6 , 26 ]. Imaging findings usually comprise irregular osteolytic destruction of the vertebral bodies with or without paraspinal abscess [ 7 , 12 , 13 ].…”

“…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 ]. Puncture biopsy, an invasive examination for obtaining a specimen, is generally performed under the guidance of CT, which was associated with less trauma and high accuracy in diagnosing spine cryptococcal osteomyelitis in some cases [ 3 , 10 , 16 , 20 , 25 ].…”