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Cryptococcal osteomyelitis of the skull.
Juan E Corral1, Sandra Lima, Julio Quezada
1Asociación de Salud Integral, Hospital General San Juan de Dios, Guatemala City, Guatemala. kyke@ufm.edu
Medical Mycology
|February 3, 2011
Summary
A rare scalp mass in an HIV-negative man was Cryptococcus neoformans osteomyelitis, likely from direct inoculation. This fungal infection requires consideration in scalp masses, with surgical and antifungal treatment offering good recovery.
Area of Science:
- Infectious Diseases
- Mycology
- Surgical Pathology
Background:
- Cryptococcus neoformans typically causes disseminated disease in immunocompromised individuals.
- Osteomyelitis is a rare complication of cryptococcal infections, usually following fungemia.
Observation:
- A 65-year-old HIV-negative male presented with a non-tender scalp mass.
- Needle aspiration revealed yeast cells confirmed as Cryptococcus neoformans.
- Radiographic imaging showed osteolytic lesions in the parietal bone.
Findings:
- This case represents a rare instance of direct inoculation leading to cryptococcal osteomyelitis of the scalp in an HIV-negative patient.
- A review of 11 similar cases since 1983 identified insidious scalp masses with osteolytic lesions in HIV-negative individuals.
- Most patients (9/11) recovered after surgical debridement and antifungal therapy (amphotericin B, flucytosine, fluconazole).
Implications:
- Cryptococcal osteomyelitis should be included in the differential diagnosis for unexplained scalp masses, particularly in HIV-negative patients.
- Prompt diagnosis and treatment, including surgical intervention and appropriate antifungals, are crucial for favorable outcomes.
- Direct inoculation is a potential route for cryptococcal osteomyelitis, challenging the typical understanding of disease progression.
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