Ma Jing-Long, Liao Liang, Wan Tao, Yang Fu-Chun
Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China.
World J Clin Cases. 2022 Jul 6;10(19):6617-6625. doi: 10.12998/wjcc.v10.i19.6617.
Cryptococcal osteomyelitis is a bone infection caused by cryptococcus. As an opportunistic infection, bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease. Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person. The pathogenic fungus often invades vertebrae, femur, tibia, rib, clavicle, pelvis, and humerus, but the ulna is a rare target.
A 79-year-old woman complaining of chronic pain, skin ulceration and a sinus on her right forearm was admitted, and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna. Unexpectedly, she was also found to have apparently normal immunity. After treatment with antifungal therapy combined with surgery debridement, the patient's osteomyelitis healed with a satisfactory outcome.
Although rare, cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients, and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.
隐球菌性骨髓炎是由隐球菌引起的骨感染。作为一种机会性感染，骨隐球菌病通常发生在免疫缺陷疾病患者或接受免疫抑制治疗的患者中，并且常表现为播散性疾病的特征。孤立性隐球菌性骨髓炎在免疫功能正常的人中极为罕见。致病真菌常侵犯椎骨、股骨、胫骨、肋骨、锁骨、骨盆和肱骨，但尺骨是罕见的受累部位。
一名79岁女性因右前臂慢性疼痛、皮肤溃疡和窦道入院，随后不久被诊断为右尺骨隐球菌性骨髓炎。出乎意料的是，她的免疫功能似乎正常。经过抗真菌治疗联合手术清创后，患者的骨髓炎愈合，预后良好。
尽管罕见，但即使在免疫功能正常的患者中，隐球菌性骨髓炎也应在溶骨性病变的鉴别诊断中予以考虑，若能早期明确诊断并进行病因治疗，有望获得良好的预后。
