Li Yanwei, Zhang Jinhui, Lü Lianchi, Hong Haisen, Wang Qingfen, Chen Changqing
Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, Fujian Province, China.
Department of Pharmacy, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, Fujian Province, China.
Heliyon. 2024 Sep 14;10(19):e37514. doi: 10.1016/j.heliyon.2024.e37514. eCollection 2024 Oct 15.
is an opportunistic fungal pathogen widely distributed in nature, commonly found in soil and bird droppings such as pigeons. Cryptococcal osteomyelitis is usually found in immunocompromised patients, in an unusual condition Cryptococcus invades the bone. It usually occurs as a part of disseminated infection and is rarely isolated, and isolated cryptococcal osteomyelitis of the radius is rarer.
We report a case of a 41-year-old woman with no underlying disease who presented with progressive distal swelling of the left forearm. The patient was initially suspected by local doctors of a malignant bone tumor. For further diagnosis, we performed a computed tomography-guided biopsy of the radius and found granulomatous inflammation with massive macrophage infiltration and a specific stain showing mycosis. Genetic testing revealed a high abundance of . We performed debridement of the radius and filled the bone defect with antifungal calcium sulfate. Fluconazole was taken orally for 3 months after operation. No recurrence was found in the 15-month follow-up.
It is the second case of Cryptococcus osteomyelitis as the only manifestation of extrapulmonary disease since 1973. It should be a safe and effective method to eliminate dead space, release antifungal drugs for a long time and increase bone stability by filling bone defect with antifungal drugs and calcium sulfate bone powder.
隐球菌是一种机会性真菌病原体，广泛分布于自然界，常见于土壤和鸽粪等鸟类粪便中。隐球菌性骨髓炎通常见于免疫功能低下的患者，在一种不寻常的情况下，隐球菌会侵入骨骼。它通常作为播散性感染的一部分出现，很少单独发生，而孤立性桡骨隐球菌性骨髓炎则更为罕见。
我们报告一例41岁无基础疾病的女性患者，其表现为左前臂远端进行性肿胀。患者最初被当地医生怀疑患有恶性骨肿瘤。为进一步诊断，我们对桡骨进行了计算机断层扫描引导下的活检，发现肉芽肿性炎症伴大量巨噬细胞浸润，特异性染色显示为真菌病。基因检测显示某种菌的丰度很高。我们对桡骨进行了清创，并使用抗真菌硫酸钙填充骨缺损。术后口服氟康唑3个月。在15个月的随访中未发现复发。
这是自1973年以来第二例以隐球菌性骨髓炎作为肺外疾病唯一表现的病例。用抗真菌药物和硫酸钙骨粉填充骨缺损以消除死腔、长时间释放抗真菌药物并增加骨稳定性应是一种安全有效的方法。
