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Case Reports
. 2021 Feb 24:14:719-722.
doi: 10.2147/IDR.S294299. eCollection 2021.

Osteoarticular Cryptococcosis Successfully Treated with High-Dose Liposomal Amphotericin B Followed by Oral Fluconazole

Guillem Deus  1 , Silvia Gómez-Zorrilla  1 , Daniel Echeverria-Esnal  2 , Ana Siverio  3 , Robert Güerri-Fernandez  1 , Jesús Ares  4 , Nuria Campillo  2 , Emili Letang  1   5 , Hernando Knobel  1 , Santiago Grau  2 , Juan Pablo Horcajada  1
Affiliations
Case Reports

Osteoarticular Cryptococcosis Successfully Treated with High-Dose Liposomal Amphotericin B Followed by Oral Fluconazole

Guillem Deus et al. Infect Drug Resist. .

Abstract

Background: Skeletal involvement of Cryptococcus neoformans is infrequent and usually associated with disseminated cryptococcosis or underlying predisposing conditions. We present an atypical case of osteoarticular cryptococcosis in an immunocompetent patient.

Case presentation: We herein report a case of bone and soft tissue cryptococcal infection in a 42-year-old male from Pakistan with well-controlled diabetes without other associated immunodeficiencies treated with antifungal therapy without surgical debridement. Furthermore, the patient developed toxidermia due to fluconazole use, so a fluconazole desensitization was performed. Therapeutic management also included the performance of therapeutic drug monitoring of fluconazole plasma concentrations.

Conclusion: To our knowledge, this is the first case of osteoarticular cryptococcosis treated with this treatment regimen. This strategy may be of interest to try to reduce hospital stay and associated complications.

Keywords: Cryptococcus neoformans; fluconazole desensitization; immunocompetent; liposomal amphotericin B; osteoarticular cryptococcosis.

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Conflict of interest statement

Juan Pablo Horcajada reports being a speaker with honoraria advisory boards for MSD, Pfizer, and Menarini. The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Transverse computed tomography image of the pelvis.
See this image and copyright information in PMC

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