Asociación de Salud Integral, Hospital General San Juan de Dios, Guatemala City, Guatemala.
Med Mycol. 2011 Aug;49(6):667-71. doi: 10.3109/13693786.2011.558124. Epub 2011 Feb 2.
An otherwise healthy 65-year-old male from a rural area presented with a 1-month old non-tender scalp mass. He had a history of being stuck with a stone in the parietal region a year earlier but hadn't developed any complications. Needle aspiration of the mass revealed numerous yeast cells, which were confirmed to be Cryptoccus neoformans. This case describes a rare presentation of C. neoformans infection in a human immunodeficiency virus (HIV)-negative patient. Moreover, while osteomyelitis due to Cryptococcus is generally preceded by fungemia, in the present case it was caused by direct inoculation of the etiologic agent. We review 11 similar cases published since 1983 in which most of the patients developed an insidious mass in their scalps with osteolytic lesions as seen on X-ray and all were HIV-negative. Nine of the eleven patients in these cases had good recovery after surgical debridement and treatment with amphotericin B, flucytocise and/or fluconazole. The remaining two patients died during hospitalization. Cryptococcal osteomyelitis should be part of a differential diagnosis when confronted with an insidious growing mass or abscess of unclear origin in the scalp.
一位来自农村地区、身体原本健康的 65 岁男性，出现了一个为期 1 个月的、无触痛的头皮肿块。他在一年前曾被一块石头击中头顶，但没有出现任何并发症。对肿块进行的针吸检查显示出大量酵母细胞，这些细胞被确认为新型隐球菌。本病例描述了一例 HIV 阴性患者中新型隐球菌感染的罕见表现。此外，虽然由隐球菌引起的骨髓炎通常先有菌血症，但在本病例中，它是由病原体的直接接种引起的。我们回顾了自 1983 年以来发表的 11 例类似病例，其中大多数患者的头皮出现了隐匿性肿块，并伴有溶骨性病变，X 光片可见，所有患者均为 HIV 阴性。这 11 例患者中有 9 例在接受手术清创和两性霉素 B、氟胞嘧啶和/或氟康唑治疗后恢复良好。其余 2 例患者在住院期间死亡。当遇到头皮内来源不明的隐匿性生长肿块或脓肿时，应将隐球菌性骨髓炎纳入鉴别诊断。
