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Case Reports
. 2024 Feb 7:11:20499361241230149.
doi: 10.1177/20499361241230149. eCollection 2024 Jan-Dec.

Isolated cryptococcal osteomyelitis in the setting of immune reconstitution inflammatory syndrome

Pamela Horton Embrey  1 , Alexandra Long  2 , Rasha Alfattal  2 , Suimin Qiu  2 , Joseph Patrik Hornak  1
Affiliations
Case Reports

Isolated cryptococcal osteomyelitis in the setting of immune reconstitution inflammatory syndrome

Pamela Horton Embrey et al. Ther Adv Infect Dis. .

Abstract

Cryptococcal infections, though rare, must be considered in all immunocompromised patients. Patients with HIV/AIDS on antiretrovirals may have a treatment course complicated by immune reconstitution inflammatory syndrome. Here we present a case of a 38-year-old woman with HIV/AIDS with knee pain who only began to experience severe pain after induction of antiretroviral therapy. She was found to have cryptococcal osteomyelitis without dissemination to the central nervous system, an unusual presentation for immunocompromised patients. She was treated with oral fluconazole with a resolution of symptoms. This case report suggests conservative management of isolated cryptococcal infection with fluconazole, regardless of immune status.

Keywords: Cryptococcus; HIV/AIDS; case report; fluconazole; immune reconstitution inflammatory syndrome.

Plain language summary

Conservative treatment of isolated cryptococcus infection in a patient with a weakened immune system Cryptococcus neoformans is a fungus found in the soil which care rarely infect humans, especially those who have a weakened immune system, like those with HIV infection. The treatment of HIV in people with ‘secondary infections’, like cryptococcal infections, may cause patients to get worse before they get better as the immune system starts to function and attack the secondary infection. In this case report, we look at a patient who had untreated HIV who only began to develop symptoms of a secondary cryptococcal infection once treatment for HIV was started. However, because the cryptococcal infection was only in her bone and not throughout her body and nervous system, we were able to treat her with a conservative, oral regimen. In patients with severe cryptococcal infection or with infection of their nervous system, they often need to be treated with medications that can cause a lot of unwanted side effects. The key takeaway from this article is that conservative treatment of Cryptococcus may be effective, even in people with weakened immune systems, as long as the cryptococcal infection is isolated.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Mucicarmine staining using a Ventana staining kit of a bone fragment demonstrates the presence of a mucopolysaccharide capsule.
See this image and copyright information in PMC

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