Cryptococcal infection presenting as soft tissue abscess and arthritis: Case report.
Abscess
/ diagnosis
Aged
Antifungal Agents
/ therapeutic use
Arthritis
/ diagnosis
Cryptococcosis
/ diagnosis
Cryptococcus neoformans
Diagnosis, Differential
Female
Fluconazole
/ therapeutic use
Flucytosine
/ therapeutic use
Humans
Immunocompromised Host
/ physiology
Kidney Transplantation
Male
Middle Aged
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
16 Jul 2021
16 Jul 2021
Historique:
received:
25
04
2021
accepted:
28
06
2021
entrez:
14
7
2021
pubmed:
15
7
2021
medline:
30
7
2021
Statut:
ppublish
Résumé
Cryptococcal infection has been documented in immunocompromised patients. AIDS and renal transplant recipients account for majority of the cases. Most cases present with central nervous system or disseminated disease, with only few presenting soft tissue, bone, and joint manifestations. We present a case of soft tissue mass in a 66-year-old female renal transplant recipient and that of arthritis in a 64-year-old immunocompetent man who presented pseudogout arthropathy. Chest radiographies of both cases were negative. Biopsy revealed cryptococcal organisms. Blood culture or cerebrospinal fluid sampling indicated positive results for cryptococcal antigen. Cryptococcus neoformans was recovered in the wound culture. The patients received intravenous fluconazole and flucytosine, followed by oral fluconazole administration. Symptomatic improvements were achieved and no subsequent relapses were observed. The authors experienced 2 cases of cryptococcosis with very unusual clinical presentation. Early clinical suspicion and serum cryptococcal antigen testing can help in rapid appropriate diagnosis in immunocompetent as well as immunocompromised patients even in the absence of pulmonary involvement.
Identifiants
pubmed: 34260570
doi: 10.1097/MD.0000000000026656
pii: 00005792-202107160-00053
pmc: PMC8284701
doi:
Substances chimiques
Antifungal Agents
0
Fluconazole
8VZV102JFY
Flucytosine
D83282DT06
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26656Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
DiNardo AR, Schmidt D, Mitchell A, et al. First description of oral Cryptococcus neoformans causing osteomyelitis of the mandible, manubrium and third rib with associated soft tissue abscesses in an immunocompetent host. Clin Microbiol Case Rep 2015;1:017.
Pappas PG, Perfect JR, Cloud GA, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis 2001;33:690–9.
Henao-Martínez AF, Beckham JD. Cryptococcosis in solid organ transplant recipients. Curr Opin Infect Dis 2015;28:300–7.
Singh N, Forrest G. Cryptococcosis in solid organ transplant recipients. Am J Transplant 2009;9: (Suppl 4): S192–8.
Wood L, Miedzinski L. Skeletal cryptococcosis: case report and review of the literature. Can J Infect Dis 1996;7:125–32.
Harris RM, Stillman IE, Goldsmith JD, et al. Pathological rib fracture and soft tissue mass simulating malignancy-Cryptococcus, an unsuspected culprit. Diagn Microbiol Infect Dis 2015;81:189–91.
Poenaru SM, Rofaiel R, Hosseini-Moghaddam SM. Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient. BMJ Case Rep 2017;11:bcr2017221650.
Sinnott JT 4th, Holt DA. Cryptococcal pyarthrosis complicating gouty arthritis. South Med J 1989;82:1555–6.
Bosch X, Ramón R, Font J, et al. Bilateral cryptococcosis of the hip. A case report. J Bone Joint Surg Am 1994;76:1234–8.
Bruno KM, Farhoomand L, Libman BS, et al. Cryptococcal arthritis, tendinitis, tenosynovitis, and carpal tunnel syndrome: report of a case and review of the literature. Arthritis Rheum 2002;47:104–8.
Bunning RD, Barth WF. Cryptococcal arthritis and cellulitis. Ann Rheum Dis 1984;43:508–10.
Geller DS, Pope JB, Thornhill BA, Dorfman HD. Cryptococcal pyarthrosis and sarcoidosis. Skeletal Radiol 2009;38:721–7.
Mokrzycki A, Meyssonnier V, Heym B, et al. Cryptococcal arthritis in an immunocompetent migrant. J Travel Med 2020;27:taaa028.
Sing Y, Ramdial PK. Cryptococcal inflammatory pseudotumors. Am J Surg Pathol 2007;31:1521–7.
Ramkillawan Y, Dawood H, Ferreira N. Isolated cryptococcal osteomyelitis in an immune-competent host: a case report. Int J Infect Dis 2013;17:e1229–31.
Collins VP. Bone involvement in cryptococcosis. Am J Roentgenol 1950;63:102–12.
Pereira-Duarte M, Camino G, Estefan M, et al. Criptococosis vertebral. Comunicación de un caso y revisión bibliográfica [Vertebral cryptococosis. Case report and literature review]. Rev Chilena Infectol 2019;36:656–62.
Doty JD, Mazur JE, Judson MA. Treatment of sarcoidosis with infliximab. Chest 2005;127:1064–71.
Yee AM, Pochapin MB. Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med 2001;135:27–31.
Schimpff SC, Bennett JE. Abnormalities in cell-mediated immunity in patients with Cryptococcus neoformans infection. J Allergy Clin Immunol 1975;55:430–41.