Article Text

Download PDFPDF
Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient
  1. Sonia Maria Poenaru,
  2. Rymon Rofaiel,
  3. Seyed M Hosseini-Moghaddam
  1. Department of Medicine, Western University, London, Ontario, Canada
  1. Correspondence to Dr Seyed M Hosseini-Moghaddam, seyed.hosseini{at}


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.

  • bone and joint infections
  • infections
  • acute renal failure
  • transplantation

Statistics from


  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.