[Cryptococcal osteomyelitis in a patient with a lymphocytic leukemia treated with fludarabine-cyclophosphamide-rituximab]

N Ettahar; L Legout; F Ajana; P Patoz; M Massongo; C Rose; E Senneville

doi:10.1016/j.mycmed.2012.12.049

[Cryptococcal osteomyelitis in a patient with a lymphocytic leukemia treated with fludarabine-cyclophosphamide-rituximab]

J Mycol Med. 2013 Mar;23(1):57-63. doi: 10.1016/j.mycmed.2012.12.049. Epub 2013 Jan 29.

[Article in French]

Authors

N Ettahar¹, L Legout, F Ajana, P Patoz, M Massongo, C Rose, E Senneville

Affiliation

¹ Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Dron, rue du Président-Coty, 59208 Tourcoing, France. [email protected]

PMID: 23375857
DOI: 10.1016/j.mycmed.2012.12.049

Abstract

Introduction: Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms.

Observation: A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed.

Conclusion: Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement.

Publication types

Case Reports
Review

MeSH terms

Aged
Antibodies, Monoclonal, Murine-Derived / administration & dosage
Antibodies, Monoclonal, Murine-Derived / adverse effects
Antifungal Agents / therapeutic use
Antineoplastic Combined Chemotherapy Protocols / adverse effects*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Cryptococcosis / drug therapy
Cryptococcosis / etiology*
Cryptococcosis / microbiology
Cryptococcus neoformans / isolation & purification*
Cutaneous Fistula / etiology
Cutaneous Fistula / microbiology
Cyclophosphamide / administration & dosage
Cyclophosphamide / adverse effects
Diabetes Mellitus, Type 2 / complications
Female
Fungemia / drug therapy
Fungemia / etiology*
Fungemia / microbiology
Humans
Immunocompromised Host
Immunosuppressive Agents / administration & dosage
Immunosuppressive Agents / adverse effects
Leukemia, Lymphocytic, Chronic, B-Cell / complications
Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
Lung Diseases, Fungal / drug therapy
Lung Diseases, Fungal / etiology
Lung Diseases, Fungal / microbiology
Neutropenia / chemically induced
Neutropenia / complications
Opportunistic Infections / drug therapy
Opportunistic Infections / etiology
Opportunistic Infections / microbiology*
Osteolysis / etiology
Osteomyelitis / drug therapy
Osteomyelitis / etiology
Osteomyelitis / microbiology*
Rituximab
Vidarabine / administration & dosage
Vidarabine / adverse effects
Vidarabine / analogs & derivatives

Substances

Antibodies, Monoclonal, Murine-Derived
Antifungal Agents
Immunosuppressive Agents
Rituximab
Cyclophosphamide
Vidarabine
fludarabine