Infect Chemother.  2008 Oct;40(5):284-287. 10.3947/ic.2008.40.5.284.

A Case of Cryptococcal Osteomyelitis with Paraspinal Abscess

• Oh R
• Song EH
• Park KH
• Cho OH
• Kim T
• Yun GJ
• Sohn BS
• Sung H
• Kim MN
• Kim YS
• Woo JH

• KMID: 2285054
• DOI: http://doi.org/10.3947/ic.2008.40.5.284

Abstract

Cryptococcosis is a disseminated infection caused by Cryptococcus neoformans. It usually causes pulmonary infection and meningitis in immunocompromised patients. However, osteomyelitis due to C. neoformans is extremely rare. It is generally known that cryptococcal osteomyelitis is a complication of disseminated cryptococcosis, appearing in 5-10%. We experienced a case of cryptococcal osteomyelitis with paraspinal abscess in a liver transplant patient.

Keyword

Cryptococcus neoformans; Cryptococcal Osteomyelitis; Paraspinal Abscess

MeSH Terms

Abscess
Cryptococcosis
Cryptococcus neoformans
Humans
Immunocompromised Host
Liver
Meningitis
Osteomyelitis
Transplants

Figure

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  Figure 1 (A) Initial magnetic resonance imaging shows a paraspinal abscess (arrow) and destruction of iliac bone (arrowhead). It involves erector spine muscle and iliac muscle. (B) Magnetic resonance imaging 4 weeks after the treatment shows decreased size of abscess.

Reference

1. Lee MS, Woo JH. Pulmonary cryptococcosis. Korean J Infect Dis. 1998. 30:86–93.

2. Choe KW. Cryptococcosis. J Korean Med Assoc. 1987. 30:858–862.

3. Woo JH. Pneumonia and clinical understanding. 1998. Ulsan: Ulsan University Press;169.

4. Liu PY. Cryptococcal osteomyelitis: case report and review. Diagn Microbiol Infect Dis. 1998. 30:33–35.

5. Govender S, Mutasa S, Parbhoo AH. Cryptococcal osteomyelitis of the spine. J Bone Joint Surg Br. 1999. 81:459–461.

6. AI-Tawfiq JA, Ghandour J. Cryptococcus neoformans abscess and osteomyelitis in an immunocompetent patient with tuberculous lymphadenitis. Infection. 2007. 35:377–382.

7. Maliner LI. Successful treatment of cryptococcal osteomyelitis and paraspinous abscess. South Med J. 2002. 95:945.

8. Chang WC, Tzao C, Hsu HH, Chang H, Lo CP, Chen CY. Isolated cryptococcal thoracic empyema with osteomyelitis of the rib in an immunocompetent host. J Infect Dis. 2005. 51:e117–e119.

9. Goldshteyn N, Zanchi A, Cooke K, Agha R. Cryptococcal osteomyelitis of the humeral head initially diagnosed as avascular necrosis. South Med J. 2006. 99:1140–1141.

10. Gurevitz O, Goldschmied-Reuven A, Block C, Kopolovic J, Farfel Z, Hassin D. Cryptococcus neoformans vertebral osteomyelitis. J Med Vet Mycol. 1994. 32:315–318.

11. Italiano A, Yen BC, Rosenthal SA, Rafii M. Cryptococcal osteomyelitis with septic arthritis. Orthopedics. 2001. 24:59–60.

12. Su CT, Chen LK, Tsai YF, Kuo CJ, Lu CL, Chen HY. Disseminated cryptococcosis with pulmonary and marrow involvement mimicking radiological features of malignancy. J Chin Med Assoc. 2004. 67:89–92.

13. Bunning RD, Barth WF. Cryptococcal arthritis and cellulitis. Ann Rheum Dis. 1984. 42:508–510.

14. Witte DA, Chen I, Brady J, Ramzy I, Truong LD, Ostrowski ML. Cryptococcal osteomyelitis. Report of a case with aspiration biopsy of a humeral lesion with radiologic features of malignancy. Acta Cytol. 2000. 44:815–818.

15. Armonda RA, Fleckenstein JM, Brandvold B, Ondra SL. Cryptococcal skull infection: a case report with review of the literature. Neurosurgery. 1993. 32:1034–1036.