A Case of Bilateral Cryptococcal Olecranon Bursitis

Non-septic olecranon bursitis (NSOB) is the inflammation of the olecranon bursa, which is usually self-limiting with aseptic clinical manifestations. NSOB can be idiopathic or secondary to repetitive trauma or rheumatological conditions. Septic olecranon bursitis (SOB) is usually caused by bacterial skin colonisers, such as staphylococci and streptococci, and patients tend to present with systemic symptoms requiring medical and/or surgical interventions. Herein we present a case of disseminated cryptococcal infection stemming from bilateral septic olecranon bursitis in a previously healthy immunocompetent 24-year-old female. Fluid cultures were positive for Cryptococcus neoformans. Patient underwent bilateral olecranon bursectomy, washouts and debridement. Moreover, the patient was started on long-term intravenous amphotericin B and later switched to oral flucytosine and fluconazole with good effect. Patient had good clinical outcomes at one-year follow-up.  SOB secondary to unusual pathogens, such as Cryptococcus neoformans, is a rare occurrence, and tends to affect immunocompromised individuals. The clinical course of such infections has shown to be subtle and insidious, which in turn hinders the diagnosis and leads to inappropriate treatment administration. Early follow-up and consideration of these organisms, together with appropriate discussion with microbiologists and/or infectious disease teams is crucial to reduce long-term morbidity and mortality.