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Cryptococcus neoformans osteomyelitis of the calcaneus: Case report and literature review
Mauricio Esteban Ghioldi1, Eric Daniel Dealbera1, Lucas Nicolás Chemes1
1Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine.
Abstract:
Cryptococcus neoformans is an encapsulated, yeast-like fungus that can cause a systemic mycosis, particularly in immunocompromised patients. Disseminated infections typically affect the central nervous system, and osseous lesions are infrequent. Only 5%-10% of disseminated cryptococcosis involves bones. A 69-year-old female presented pain, swelling, and a soft tissue mass in her right lateral hindfoot. Her medical history included a kidney transplant (10 years earlier) secondary to chronic disease due to IgA nephropathy. The patient underwent an excisional biopsy, surgical debridement, and secondarily negative pressure wound therapy to achieve skin closure. Biopsy revealed a rare Cryptococcus neoformans osteomyelitis of the calcaneus. The patient then received IV treatment with liposomal amphotericin B at 3 mg/kg/d for 25 days. In conclusion, we present a case of cryptococcal osteomyelitis which, although not a frequent disease, must be considered as one of the differential diagnoses of osteolytic osseous lesions in patients with chronic osteomyelitis. Cryptococcus neoformans may be a potential cause of below-knee infection, mainly in immunocompromised patients.
Insights
Cryptococcus neoformans can cause rare bone infections, even below the knee, especially in immunocompromised individuals. This case highlights cryptococcal osteomyelitis as a crucial differential diagnosis for bone lesions.
Area of Science:
- Mycology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Cryptococcus neoformans is a fungus causing systemic mycosis, primarily in immunocompromised patients.
- Osseous involvement in disseminated cryptococcosis is infrequent, occurring in only 5%-10% of cases.
- Below-knee infections by C. neoformans are uncommon.
Observation:
- A 69-year-old female with a history of kidney transplant presented with hindfoot pain, swelling, and a soft tissue mass.
- Initial presentation mimicked other causes of osteolytic bone lesions.
- Biopsy confirmed rare calcaneal osteomyelitis caused by Cryptococcus neoformans.
Findings:
- Surgical debridement and negative pressure wound therapy were performed.
- The patient received intravenous liposomal amphotericin B for 25 days.
- Histopathological examination confirmed C. neoformans osteomyelitis of the calcaneus.
Implications:
- Cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic bone lesions, particularly in immunocompromised patients.
- This case underscores the potential for C. neoformans to cause infections in the lower extremities.
- Early recognition and appropriate antifungal treatment are crucial for managing this rare but serious infection.
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