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BMJ Case Reports 2017; doi:10.1136/bcr-2017-221650
  • Rare disease
  • CASE REPORT

Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient

  1. Seyed M Hosseini-Moghaddam
  1. Department of Medicine, Western University, London, Ontario, Canada
  1. Correspondence to Dr Seyed M Hosseini-Moghaddam, seyed.hosseini{at}lhsc.on.ca
  • Accepted 28 September 2017
  • Published 11 October 2017

Summary

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.

Footnotes

  • Contributors SMP collected information pertaining to the case and completed initial draft of manuscript. She also reviewed the medical literature. RR edited the draft and verified the literature review. SMH was Infectious Diseases consultant who started the treatment and continued follow-up. He reviewed and revised several drafts of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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