Pubis Cryptococcal Osteomyelitis in an Immunocompetent Patient: A Case Report and Recent Literature Review

Figures & data

Figure 1 MRI presented lesions of the pubis and surrounding soft tissue.

Figure 2 Pathology results showed fungal infection with mild dysplasia of histiocytic cells.

Figure 3 The appearance of the affected limb between different periods. (A) Broken biopsy wound, oozing viscous liquid. (B) After 12 weeks of treatment with oral fluconazole, the patient’s symptoms disappeared.

Figure 4 After 4 weeks of oral fluconazole treatment, the pubic lesions decreased in size.

Figure 5 After 12 weeks of oral fluconazole treatment, the pubic lesions basically disappeared.

Table 1 Summary of 28 Cases of Cryptococcosis of the Bones in the Last Five Years

Case no./Reference	Age/Sex	Location	ESR (mm/h)	CRP (mg/L)	Underlying Dieases	Treatment	Outcome
1^Citation27	51/F	Rib	101	109	Normal	Flu	Response
2^Citation27	47/M	Rib	41	10.3	DM, Hepatitis B, TB	Flu	Response
3^Citation28	79/F	Ulna	66	74.26	Normal	Surgery+Flu+Vor	Response
4^Citation29	36/M	Skull	NA	Normal	Liver transplantation	Surgery+AMB+5-FC +Flu	Response
5^Citation30	69/F	Calcaneus	28	NA	renal transplantation	Surgery+AMB	Response
6^Citation31	70/M	Humerus	NA	52.8	Normal	Flu	Response
7^Citation32	42/M	Ilium	NA	NA	DM	AMB+Flu	Response
8^Citation33	63/M	Phalange	NA	NA	LPL	Surgery+Flu	Response
9^Citation34	29/M	Ankle and elbow joint	43	29.5	Normal	Surgery+Flu	Response
10^Citation35	25/M	Spine	62	44	Osteosarcoma	Surgery+AMB	Response
11^Citation36	35/M	Spine	NA	NA	HIV	AMB+Flu	Death
12^Citation37	18M	Scapula and Tibia	93	NA	TB	Surgery+AMB+5-FC+Flu	Response
13^Citation38	25/M	Rib	Normal	Normal	TB	AMB+5-FC+Flu	Response
14^Citation39	48/M	Skull	NA	NA	HIV	AMB+5-FC+Flu	Response
15^Citation40	46/F	Ilium	Normal	Normal	Normal	Surgery+AMB+5-FC+Flu+Vor	Response
16^Citation41	78/M	Zygomatic	35	Normal	Cancer radiotherapy	Flu	Response
17^Citation42	31/M	Mandible and Clavicle	NA	38	Normal	Surgery+AMB+5-FC+Flu	Response
18^Citation43	11/M	Rib	NA	NA	Lung transplantation	Flu+5-FC	Response
19^Citation44	17/F	Spine	NA	NA	Normal	Flu+5-FC	Response
20^Citation45	41/M	Spine	62	NA	Normal	Flu	Response
21^Citation46	53/M	Patella	NA	NA	Liver transplantation, DM	AMB+5-FC+Flu	Response
22^Citation20	36/M	Scapula	NA	NA	Normal	AMB+Flu	Response
23^Citation20	57/M	Femur	NA	NA	Normal	AMB+Flu+Surgery	Response
24^Citation20	57/F	Ulna	NA	NA	SLE	Flu	Response
25^Citation20	51/M	Humerus	NA	NA	Sarcoidosis, corticosteroid therapy	Flu	Response
26^Citation20	52/F	Skull	NA	NA	Normal	Surgery+Flu	Response
27^Citation47	42/F	Metatarsal	NA	NA	Normal	Surgery+Flu	Response
28^Citation48	65/M	Spine	41	17.2	Renal transplantation, DM	AMB+Flu +Surgery	Response

Notes: There are 28 Cryptococcal Osteomyelitis cases in the recent years, involving clinical characters, therapy, outcome et al.

Abbreviations: NA, not available; 5-FC, 5-fluorocytosine; Flu, fluconazole; Vor: Voriconazole; LPL, lymphoplasmacytic lymphoma; TB, tuberculosis, SLE, systemic lupus erythematosus; DM, diabetes mellitus.

Zhang C, Wang C, Chen F, et al. Metagenomic next-generation sequencing technique helps identify cryptococcal infection in the rib: a report of 2 cases and review of the literature. JBJS Case Connect. 2019;9(4):e0367. doi:10.2106/JBJS.CC.19.00367

 Google Scholar

Ma JL, Liao L, Wan T, Yang FC. Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient: a case report. World J Clin Cases. 2022;10(19):6617–6625. doi:10.12998/wjcc.v10.i19.6617

 Web of Science ®Google Scholar

Pudipeddi AV, Liu K, Watson GF, Davis RJ, Strasser SI. Cryptococcal osteomyelitis of the skull in a liver transplant patient. Transpl Infect Dis. 2016;18(6):954–956. doi:10.1111/tid.12602

 Web of Science ®Google Scholar

Ghioldi ME, Dealbera ED, Chemes LN, Caballero GA, Del Vecchio JJ. Cryptococcus neoformans osteomyelitis of the calcaneus: case report and literature review. SAGE Open Med Case Rep. 2021;9:2050313X211027094. doi:10.1177/2050313X211027094

 Web of Science ®Google Scholar

Onishi O, Kida Y, Kiba T, et al. Cryptococcal osteomyelitis of the entire humerus: a case report. JBJS Case Connect. 2020;10(4):e2000279. doi:10.2106/JBJS.CC.20.00279

 Google Scholar

Deus G, Gomez-Zorrilla S, Echeverria-Esnal D, et al. Osteoarticular cryptococcosis successfully treated with high-dose liposomal amphotericin B followed by oral fluconazole. Infect Drug Resist. 2021;14:719–722. doi:10.2147/IDR.S294299

 Web of Science ®Google Scholar

Chen WA, Emory CL, Graves BR. Disseminated Cryptococcal Osteomyelitis to the Hand in an Immunosuppressed Lymphoma Patient. J Hand Surg Am. 2018;43(3):291e291–291 e296. doi:10.1016/j.jhsa.2017.07.013

 Web of Science ®Google Scholar

Dumenigo A, Sen M. Cryptococcal Osteomyelitis in an Immunocompetent Patient. Cureus. 2022;14(1):e21074. doi:10.7759/cureus.21074

 Web of Science ®Google Scholar

Lai Q, Liu Y, Yu X, et al. Diagnosis and treatment of nonadjacent cryptococcal infections at the L1 and S1 vertebrae. Orthopade. 2017;46(1):85–89. doi:10.1007/s00132-016-3349-3

 Web of Science ®Google Scholar

Marino A, Caltabiano E, Zagami A, et al. Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report. BMC Infect Dis. 2018;18(1):693. doi:10.1186/s12879-018-3573-z

 Web of Science ®Google Scholar

Delat R, Laheri V. Bifocal cryptococcal osteomyelitis in an immunocompetent male. J Orthop Case Rep. 2016;6(5):17–19. doi:10.13107/jocr.2250-0685.610

 Google Scholar

Ramesh V, Rao Polati V, Nimmala P, Anand M, Narreddy S, Saidulu G. An unusual cause for rib osteomyelitis in the tropics: cryptococcal osteomyelitis. Trop Doct. 2020;50(4):361–365. doi:10.1177/0049475520929827

 Web of Science ®Google Scholar

Adiwardana NS, Moras JA, Bernardo LL, Klautau GB, Queiroz W, Vidal JE. Chronic skull osteomyelitis due to Cryptococcus neoformans: first case report in an HIV-infected patient. Braz J Infect Dis. 2018;22(6):499–502. doi:10.1016/j.bjid.2018.11.004

 PubMed Web of Science ®Google Scholar

Sang J, Yang Y, Fan Y, et al. Isolated iliac cryptococcosis in an immunocompetent patient. PLoS Negl Trop Dis. 2018;12(3):e0006206. doi:10.1371/journal.pntd.0006206

 Web of Science ®Google Scholar

Matsuki T, Miyamoto S, Yamashita T. Cryptococcal osteomyelitis of the Zygomatic bone: a case report. BMC Infect Dis. 2020;20(1):399. doi:10.1186/s12879-020-05123-2

 Web of Science ®Google Scholar

Inoue H, Motohashi T, Ioku Y, Watanabe M, Nakajima M, Sugitatsu M. The detection of Cryptococcus in skeletal infection after tooth extraction in an acute myeloid leukemia patient. IDCases. 2020;19:e00700. doi:10.1016/j.idcr.2020.e00700

 Web of Science ®Google Scholar

Schrader A, Melicoff E, Munoz F, Mallory GB, Curry CV, Gazzaneo MC. Diagnosis and treatment of cryptococcal osteomyelitis in a pediatric lung transplant patient. Pediatr Transplant. 2022;26(2):e14165. doi:10.1111/petr.14165

 Web of Science ®Google Scholar

Li Z, Liang J, Shen J, Qiu G, Weng X. Thoracolumbar scoliosis due to cryptococcal osteomyelitis: a case report and review of the literature. Medicine. 2016;95(5):e2613. doi:10.1097/MD.0000000000002613

 Web of Science ®Google Scholar

Wang R, Luo H, Xin X, Qin B, Huang W. Disseminated cryptococcal infection of the lumbar Spine in an immunocompetent man. Infect Drug Resist. 2022;15:4229–4234. doi:10.2147/IDR.S359612

 Web of Science ®Google Scholar

Poenaru SM, Rofaiel R, Hosseini-Moghaddam SM. Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient. BMJ Case Rep. 2017;2017. doi:10.1136/bcr-2017-221650

 Google Scholar

Medaris LA, Ponce B, Hyde Z, et al. Cryptococcal osteomyelitis: a report of 5 cases and a review of the recent literature. Mycoses. 2016;59(6):334–342. doi:10.1111/myc.12476

 Web of Science ®Google Scholar

Ahn JH, Park C, Lee CW, Kim YC. Cryptococcal osteomyelitis of the first metatarsal head in an immunocompetent patient. J Am Podiatr Med Assoc. 2017;107(3):248–252. doi:10.7547/16-067

 Web of Science ®Google Scholar

Pereira-Duarte M, Camino G, Estefan M, Kido G, Sola C, Gruenberg M. Criptococosis vertebral. Comunicación de un caso y revisión bibliográfica [Vertebral cryptococosis. Case report and literature review]. Rev Chilena Infectol. 2019;36(5):656–662. Spanish. doi:10.4067/S0716-10182019000500656

 Google Scholar