Cryptococcus neoformans causing localised osteomyelitis of the right anterior rib

Cryptococcus neoformans most commonly causes pulmonary and central nervous system infections, with skeletal involvement usually occurring as part of disseminated disease in profoundly immunocompromised hosts. We describe an HIV-negative man in his early 50s from South Africa with sarcoidosis, type 1 diabetes mellitus and chronic kidney disease who presented with a 1 month history of a localised swelling over the right anterior chest wall. CT demonstrated an expansile lesion of the right sixth anterior rib. Biopsy and culture confirmed C. neoformans with fluconazole non-susceptibility. The patient was treated with 12 months of voriconazole, achieving clinical and radiological resolution without surgical intervention.