Cryptococcal osteomyelitis in an adolescent survivor of T-cell acute lymphoblastic leukemia

Abstract

Cryptococcosis is infrequent in children, and isolated cryptococcal osteomyelitis is rarely encountered. Here, we describe a 14-year-old patient in remission from T-cell acute lymphoblastic leukemia with osteomyelitis because of Cryptococcus neoformans var. grubii. The patient was effectively treated with antifungal therapy.

Figure 1. Laboratory and Imaging Studies over Time

Time course of laboratory findings and antimicrobial treatment (A); STIR- weighted MRI images of the left ankle at initial presentation (B) and on re-admission a month later (C), demonstrating size increase of an intraosseous abscess (→) within the head and neck of the talus and extensive surrounding marrow edema corresponding to osteomyelitis; histopathological images (×40 magnification) showing cryptococci within the bone using GMS stain (D); robust mating between the clinical isolate (mating type α) and the test strain (mating type a), indicated by the presence of hyphae at the mating patch edge (×10, E), and basidia with chains of basidiospores (×40, F; ×100, G). Day 1 denotes the day of the first hospital admission, prior to which the patient was neutropenic and lymphopenic. WBC, White Blood Cell Count; ANC, Absolute Neutrophile Count; ALC, Absolute Lymphocyte Count; Cip., Ciprofloxacin; Merop., Meropenem; Flucon., Fluconazole; I&D, surgical irrigation and debridement.