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Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient
Sonia Maria Poenaru1, Rymon Rofaiel1, Seyed M Hosseini-Moghaddam1
1Department of Medicine, Western University, London, Ontario, Canada.
Abstract:
Cryptococcus neoformans is an important pathogen that can cause severe illness and mortality in immunocompromised patients. We highlight here the case of a 53-year-old man presenting to hospital 4 years postliver transplant with fever, acute renal failure and a medial thigh lesion. Initially treated as bacterial sepsis, the patient failed to improve on broad-spectrum antibiotics. Further investigations revealed disseminated cryptococcemia complicated by patellar osteomyelitis and an intramuscular abscess. Unfortunately, although the patient initially showed signs of clinical improvement after starting standard antifungal agents, he deteriorated and died secondary to acute renal failure. Osteomyelitis is a rare manifestation of cryptococcal infection for which there is often a significant delay to diagnosis and treatment. This is the fourth reported case of cryptococcal osteomyelitis in a liver transplant patient and underlines the importance of considering fungal infections in the differential diagnosis of osseous lesions in solid organ transplant and other immunocompromised patients.
Insights
Cryptococcus neoformans can cause severe illness in immunocompromised individuals. This case highlights cryptococcal osteomyelitis in a liver transplant patient, emphasizing the need for early fungal infection diagnosis.
Area of Science:
- Infectious Diseases
- Mycology
- Transplant Medicine
Background:
- Cryptococcus neoformans is a significant opportunistic pathogen.
- Immunocompromised patients, particularly solid organ transplant recipients, are at high risk for severe cryptococcal infections.
Observation:
- A 53-year-old male liver transplant recipient presented with fever, acute renal failure, and a thigh lesion.
- Initial treatment for bacterial sepsis was ineffective, leading to further investigation.
Findings:
- Disseminated cryptococcemia was diagnosed, complicated by patellar osteomyelitis and an intramuscular abscess.
- Despite initial response to antifungal therapy, the patient succumbed to acute renal failure.
Implications:
- Osteomyelitis is a rare but serious manifestation of cryptococcal infection.
- Early consideration of fungal infections is crucial for diagnosing osseous lesions in immunocompromised patients, including liver transplant recipients.
