Case Report

Cryptococcal Osteomyelitis of the Humeral Head Initially Diagnosed as Avascular Necrosis

Authors: Natalya Goldshteyn, MD, Antonela Zanchi, MD, Kenneth Cooke, MD, Rabia Agha, MD

Abstract

Cryptococcal skeletal infections can lead to significant morbidity and mortality and should be considered in the differential diagnosis of lytic osseous lesions. Clinical and radiological similarities to various disorders may lead to delay in initiation of antifungal treatment. This report describes a case of cryptococcal osteomyelitis of humeral bone in a 19-year-old female, emphasizing the clinical presentation, diagnostic approach and treatment options.


Key Points


* Disseminated cryptococcosis usually occurs in patients with defective cellular immunity. Incidence of skeletal involvement is estimated at 5%.


* Typical radiological presentation is a lytic lesion with mild or absent periosteal inflammation.


* Surgical biopsy is the most effective diagnostic modality.


* Cryptococcal skeletal infections should be considered in the differential diagnosis of lytic osseous lesions.


* Clinical and radiological resemblance of various disorders may lead to delayed start of treatment.

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