Pyrexia of unknown origin in a healthy adult: a case report
DOI:
https://doi.org/10.18203/2349-3933.ijam20240366Keywords:
Skeletal cryptococcosis, PUO, IFIAbstract
A 23-year-old male, with no known co-morbid illnesses, presented with a history of chronic fever and left hip pain of 6-months duration. The persistence of the fever with the progressive worsening of pain despite outpatient management prompted him to seek further evaluation. He was evaluated outside on multiple occasions and was diagnosed with a left sacroiliitis with left gluteal and paraspinal fluid collection 2 months prior, for which he was initiated on empirical anti tubercular treatment (ATT). In view of worsening of symptoms, he presented to our centre where he underwent a curettage and bone grafting of the left SI joint following repeat imaging. Tissue culture grew Cryptococcus neoformans and he was started on liposomal Amphoterecin B with Flucytosine. Patient clinically improved and was discharged on the same regimen. This case report aims shed light on the evidence of primary skeletal cryptococcal infection in an immunocompetent individual.
References
Lin YY, Shiau S, Fang CT. Risk factors for invasive Cryptococcus neoformans diseases: a case-control study. PLoS One. 2015;10(3):e0119090.
Eisenman HC, Casadevall A, McClelland EE. New insights on the pathogenesis of invasive Cryptococcus neoformans infection. Curr Infect Dis Rep. 2007;9(6):457-64.
Zhou HX, Ning GZ, Feng SQ, Jia HW, Liu Y, Feng HY, Ruan WD. Cryptococcosis of lumbar vertebra in a patient with rheumatoid arthritis and scleroderma: case report and literature review. BMC Infect Dis. 2013;13:128.
Nankeu S, Djaha JM, Saint Marcoux B, Kaci R, Debandt M. Disseminated cryptococcosis revealed by vertebral osteomyelitis in an immunocompetent patient. Joint Bone Spine. 2012;79(6):629-31.
Zhou B, She J, Yang L, Zhu B. Coexistent pulmonary cryptococcal infection and pulmonary sarcoidosis: a case report and literature review. J Int Med Res. 2020;48:2.
Kiertiburanakul S, Wirojtananugoon S, Pracharktam R, Sungkanuparph S. Cryptococcosis in human immunodeficiency virus-negative patients. Int J Infect Dis. 2006;10(1):72-8.
Zhou HX, Lu L, Chu T, Wang T, Cao D, Li F, et al. Skeletal cryptococcosis from 1977 to 2013. Front Microbiol. 2015;5:740.
Ramesh V, Rao Polati V, Nimmala P, Anand M, Narreddy S, Saidulu G. An unusual cause for rib osteomyelitis in the tropics: Cryptococcal osteomyelitis. Tropical Doctor. 2020;50:361-5.
Li Z, Liang J, Shen J, Qiu G, Weng X. Thoracolumbar Scoliosis Due to Cryptococcal Osteomyelitis: A Case Report and Review of the Literature. Medicine (Baltimore). 2016;95(5):e2613.
Rootjes PA, Rozemeijer W, Dutilh JC. A patient with sarcoidosis and a cryptococcal infection of the skull. Med J Aust. 2016;204:353.
Ahn JH, Park C, Lee CW, Kim Y. Cryptococcal Osteomyelitis of the First Metatarsal Head in an Immunocompetent Patient. J Am Podiatric Med Assoc. 2017;107:248-52.