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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

This summary is machine-generated.

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.

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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.