Isolated cryptococcal osteomyelitis of the humerus
Journal
Current Orthopaedic Practice
Journal Volume
21
Journal Issue
4
Date Issued
2010-07-01
Author(s)
Abstract
Cryptococcosis is a disseminated infection of humans and animals caused by Cryptococcus neoformans. It commonly involves many organs, especially the lungs and the central nervous system. Osseous involvement occurs in 5–10% of disseminated cases, but isolated osteomyelitis is rare.1 A report published in 2005 found 42 reported cases in the English literature.2 Since then, three more cases were found in the PubMed database, which we searched using the keywords “cryptococcal osteomyelitis”.3–5 A Portuguese study reported cryptococcal osteomyelitis in 75 patients from 1966 to 2004.6 The typical radiographic features are a purely lytic lesion, with discrete margins usually without periosteal reaction.7 Diagnosis of cryptococcal infection may be made by pathologic sections and culture of specimens obtained through surgical biopsy. Amphotericin B intravenously and oral flucytosine sometimes with surgical debridement usually are treatments for cryptococcal osteomyelitis.8 However, nephrotoxicity of amphotericine B and bone marrow toxicity of flucytosine are of concern. We report a 71-year-old man with cryptococcal osteomyelitis of the humeral diaphysis. He was successfully treated with surgical intervention and low-dose fluconazole. To the best of our knowledge, treatment of isolated cryptococcal osteomyelitis with only fluconazole has been reported in the English literature.2,5,8
SDGs
Other Subjects
fluconazole; isoniazid; rifampicin; aged; article; bone lesion; bone scintiscanning; case report; chronic inflammation; clinical examination; cryptococcal osteomyelitis; cryptococcosis; Cryptococcus neoformans; curettage; human; humerus; laboratory diagnosis; leukocytosis; low drug dose; lung tuberculosis; male; muscle weakness; nuclear magnetic resonance imaging; osteolysis; osteomyelitis; paresthesia; priority journal
Type
journal article