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BMJ Case Rep ; 20172017 Oct 11.
Article in English | MEDLINE | ID: mdl-29025780

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.


Subject(s)
Abscess/microbiology , Acute Kidney Injury/microbiology , Cryptococcosis/drug therapy , Cryptococcus neoformans/isolation & purification , Graft Rejection/microbiology , Liver Transplantation , Muscle, Skeletal/microbiology , Osteomyelitis/microbiology , Acute Kidney Injury/immunology , Acute Kidney Injury/physiopathology , Antifungal Agents/therapeutic use , Cryptococcosis/immunology , Cryptococcosis/physiopathology , Flucytosine/therapeutic use , Graft Rejection/immunology , Humans , Immunocompromised Host , Male , Middle Aged , Osteomyelitis/drug therapy , Osteomyelitis/immunology , Osteomyelitis/physiopathology , Rare Diseases , Thigh , Time Factors
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