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A 76-year-old male diagnosed with sarcoidosis presented with atraumatic left anterior knee pain. Initial imaging of the left lower extremity revealed an eccentrically-based lytic lesion in the mid-distal femur with cortical erosion and an additional lytic lesion in the proximal tibia. Magnetic resonance imaging (MRI) demonstrated an aggressive lesion in the proximal tibia with surrounding marrow edema, cortical breach, and erosion into the distal patellar tendon. Given concern for metastatic bone lesions, a18-fluorodeoxyglucose positron emission tomography/computed tomography scan (FDG PET/CT) was performed which demonstrated concordant hypermetabolic lytic lesions at the left mid-distal femur and the left proximal tibia, as well as hypermetabolic diffuse lymphadenopathy. The patient was presumed to have metastatic lung cancer based on the presence of lung nodules. Due to concern for impending pathologic fracture, the patient underwent open biopsy with a plan for prophylactic fixation of both lesions. Intra-operatively, however, both lesions were found to contain pus, from which cultures ultimately grew Cryptococcus neoformans. This is a case of disseminated skeletal cryptococcosis masquerading as metastatic cancer in a patient without classic risk factors for disseminated cryptococcosis (defined as extrapulmonary evidence of infection). Classically, disseminated cryptococcosis is thought to occur in severely immunocompromised patients, such as those with human immunodeficiency virus (HIV) or organ transplant recipients. This case highlights the need to maintain a high index of suspicion in patients with underlying immunocompromising conditions, including less common conditions such as sarcoid, who present with bony lesions. This case report then discusses the diagnostic evaluation and treatment of disseminated skeletal cryptococcosis. [ABSTRACT FROM AUTHOR]

Cryptococcosis is a systemic mycosis caused by yeast like fungus Cryptococcus neoformans. The infection results from inhalation of fungal spores in soil, house dust and in pigeon and other bird excreta. Infection usually occurs in immunocompromised individuals with lung and central nervous system being common sites of involvement. Skeletal involvement usually occurs as a component of disseminated cryptococcosis. Isolated skeletal involvement is rare. Here, the author presents a case of isolated skeletal cryptococcosis in an immunocompetent patient who presented with severe back pain and leg pain. Possibility of Tuberculosis of spine was suggested clinically but histopathology showed cryptococcal granulomas. Patient was HIV seronegative and did not have any other co-morbid conditions. There were no lesions in lung or brain. Because of increasing incidence of crytpococcal infections in immunocompetent hosts it should be included in the differential diagnosis of tuberculosis. Spine and fungal cultures should also be done. In the absence of fungal cultures, histopathological examination including the special stains is useful for diagnosis.

Cryptococcosis is a systemic mycosis caused by yeast like fungus Cryptococcus neoformans. The infection results from inhalation of fungal spores in soil, house dust and in pigeon and other bird excreta. Infection usually occurs in immunocompromised individuals with lung and central nervous system being common sites of involvement. Skeletal involvement usually occurs as a component of disseminated cryptococcosis. Isolated skeletal involvement is rare. Here, the author presents a case of isolated skeletal cryptococcosis in an immunocompetent patient who presented with severe back pain and leg pain. Possibility of Tuberculosis of spine was suggested clinically but histopathology showed cryptococcal granulomas. Patient was HIV seronegative and did not have any other co-morbid conditions. There were no lesions in lung or brain. Because of increasing incidence of crytpococcal infections in immunocompetent hosts it should be included in the differential diagnosis of tuberculosis. Spine and fungal cultures should also be done. In the absence of fungal cultures, histopathological examination including the special stains is useful for diagnosis. [ABSTRACT FROM AUTHOR]

Skeletal cryptococcosis, an aspect of disseminated cryptococcal disease or isolated skeletal cryptococcal infection, is a rare but treatable disease. However, limited information is available regarding its clinical features, treatment, and prognosis. This systematic review examined all cases published between April 1977 and May 2013 with regard to the factors associated with this disease, including patient sex, age, and epidemiological history; affected sites; clinical symptoms; underlying diseases; laboratory tests; radiological manifestations; and delays in diagnosis, treatment, follow-up assessments, and outcomes. We found that immune abnormality is a risk factor but does not predict mortality; these observations are due to recent Cryptococcus neoformans var gattii (CNVG) outbreaks. Dissemination was irrespective of immune status and required combination therapy, and dissemination carried a worse prognosis. Therefore, a database of skeletal cryptococcosis cases should be created.

Skeletal cryptococcosis, an aspect of disseminated cryptococcal disease or isolated skeletal cryptococcal infection, is a rare but treatable disease. However, limited information is available regarding its clinical features, treatment, and prognosis. This systematic review examined all cases published between April 1977 and May 2013 with regard to the factors associated with this disease, including patient sex, age, and epidemiological history; affected sites; clinical symptoms; underlying diseases; laboratory tests; radiological manifestations; and delays in diagnosis, treatment, follow-up assessments, and outcomes. We found that immune abnormality is a risk factor but does not predict mortality; these observations are due to recent Cryptococcus neoformans var gattii (CNVG) outbreaks (Chaturvedi and Chaturvedi, 2011). Dissemination was irrespective of immune status and required combination therapy, and dissemination carried a worse prognosis. Therefore, a database of skeletal cryptococcosis cases should be created. [ABSTRACT FROM AUTHOR]