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. 2010 Jul;44(3):336-8.
doi: 10.4103/0019-5413.65158.

Multiple osseous involvements in a case of disseminated cryptococcosis

Rakesh Singh  1 , I Xess
Affiliations

Multiple osseous involvements in a case of disseminated cryptococcosis

Rakesh Singh et al. Indian J Orthop. 2010 Jul.

Abstract

Osseous involvement occurs in 5-10% of patients with disseminated cryptococcosis. We are reporting an unusual case of disseminated cryptococcosis involving the sternum and lumbar vertebra with the formation of psoas abscess with pulmonary tuberculosis. The patient presented with fever for 3 months. A diagnosis of pulmonary tuberculosis was made on thoracic contrast-enhanced computerized tomography and she was put on antituberculosis treatment. She was immunocompetent with negative human immunodeficiency virus. She conceived subsequently and had complaints of backache and swelling over the sternum. Magnetic resonance imaging showed destruction of L5 vertebra with psoas abscess. Vertebral cryptococcosis may mimic tuberculosis and malignancy. She had a bad obstetric history and experienced five, first-trimester spontaneous abortions in each successive year since 2001. This pregnancy again resulted in spontaneous abortion. Cryptococcus neoformans was isolated from two different sites: pus-involving the sternum and ultrasound-guided psoas abscess aspirate. Serum latex agglutination test for cryptococcal capsular polysaccharide antigen was positive. The diagnosis of cryptococcosis was delayed because the patient was diagnosed as a case of pulmonary tuberculosis, wherein clinical signs, symptoms and radiological findings in both the conditions are similar. Amphotericin B was started but she developed varicella infection and expired due to cardiac failure.

Keywords: Cryptococcus neoformans; Disseminated cryptococcosis; vertebral cryptococcosis.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Contrast-enhanced computerized tomography of the thorax showing mediastinal lymphadenopathy and multiple small nodules in the right middle zone
Figure 2
Figure 2
T1W MRI mid sagittal scan showing destruction of the L5 vertebra
Figure 3
Figure 3
Clinical photograph of the same patient showing ulcerated lesion over the sternum with varicella rashes
See this image and copyright information in PMC

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