Disseminated Cryptococcus infection presenting as lytic skeletal lesions suggesting bony metastatic disease Journal Article
| Authors: | Yeung, C. M.; Fabbri, N. |
| Article Title: | Disseminated Cryptococcus infection presenting as lytic skeletal lesions suggesting bony metastatic disease |
| Abstract: | A 76-year-old male diagnosed with sarcoidosis presented with atraumatic left anterior knee pain. Initial imaging of the left lower extremity revealed an eccentrically-based lytic lesion in the mid-distal femur with cortical erosion and an additional lytic lesion in the proximal tibia. Magnetic resonance imaging (MRI) demonstrated an aggressive lesion in the proximal tibia with surrounding marrow edema, cortical breach, and erosion into the distal patellar tendon. Given concern for metastatic bone lesions, a18-fluorodeoxyglucose positron emission tomography/computed tomography scan (FDG PET/CT) was performed which demonstrated concordant hypermetabolic lytic lesions at the left mid-distal femur and the left proximal tibia, as well as hypermetabolic diffuse lymphadenopathy. The patient was presumed to have metastatic lung cancer based on the presence of lung nodules. Due to concern for impending pathologic fracture, the patient underwent open biopsy with a plan for prophylactic fixation of both lesions. Intra-operatively, however, both lesions were found to contain pus, from which cultures ultimately grew Cryptococcus neoformans. This is a case of disseminated skeletal cryptococcosis masquerading as metastatic cancer in a patient without classic risk factors for disseminated cryptococcosis (defined as extrapulmonary evidence of infection). Classically, disseminated cryptococcosis is thought to occur in severely immunocompromised patients, such as those with human immunodeficiency virus (HIV) or organ transplant recipients. This case highlights the need to maintain a high index of suspicion in patients with underlying immunocompromising conditions, including less common conditions such as sarcoid, who present with bony lesions. This case report then discusses the diagnostic evaluation and treatment of disseminated skeletal cryptococcosis. © The Author(s), under exclusive licence to International Skeletal Society (ISS) 2023. |
| Keywords: | clinical article; human tissue; aged; bone neoplasms; bone tumor; case report; drug withdrawal; bone metastasis; cancer patient; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; radiopharmaceuticals; anemia; diagnosis, differential; differential diagnosis; lung cancer; pathology; diagnostic imaging; risk factor; coronary artery bypass graft; acute kidney failure; bone lesion; lumbar puncture; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; radiopharmaceutical agent; imaging; human immunodeficiency virus; liver function test; isolation and purification; sarcoidosis; fluconazole; lymphadenopathy; graft recipient; tibia; immunocompromised patient; lung nodule; histoplasmosis; distal femur; percutaneous coronary intervention; peptic ulcer; procedures; blastomycosis; amphotericin b; cryptococcosis; cryptococcus neoformans; knee pain; pathologic fracture; upper gastrointestinal bleeding; immunocompromised patients; humans; human; male; article; orthopaedic oncology; positron emission tomography-computed tomography; positron emission tomography computed tomography; open biopsy; femur diaphysis; proximal tibia; pus; disseminated cryptococcosis; skeletal cryptococcosis; hypermetabolic diffuse lymphadenopathy; osseous sarcoidosis; tibial metaphysis |
| Journal Title: | Skeletal Radiology |
| Volume: | 53 |
| Issue: | 10 |
| ISSN: | 0364-2348 |
| Publisher: | Springer |
| Date Published: | 2024-10-01 |
| Start Page: | 2297 |
| End Page: | 2305 |
| Language: | English |
| DOI: | 10.1007/s00256-023-04442-0 |
| PUBMED: | 37749413 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK corresponding author is Nicola Fabbri -- Source: Scopus |
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