Intracranial granuloma and skull osteolysis: complication of a primary cutaneous cryptococcosis in a kidney transplant recipient.
Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients after candidiasis and aspergillosis. It occurs almost exclusively in the late posttransplantation period (>6 months after the initiation of immunosuppression). Subclinical onset of meningitis is the usual clinical presentation. Despite initiation of therapy, the mortality rate associated with this infection in this patient population remains high. To the best of our knowledge, this report describes one of the first cases of a rare entity: a primary cutaneous cryptococcosis in a renal transplant recipient disclosed by skull osteomyelitis and pseudotumoral intracranial extension. Surgical debridement and azole antifungal therapy were performed. Ten months after the onset of treatment, the patient feels good, clinical examination findings are normal, and no sign of evolutive cryptococcosis is noted.
Rerolle
Jean-Philippe
JP
Department of Nephrology and Renal Transplantation and Pathology, CHU Dupuytren, Limoges, France. jean-philippe.rerolle@chu-limoges.fr
Szelag
Jean-Christophe
JC
Diaconita
Mirela
M
Paraf
François
F
Aldigier
Jean-Claude
JC
Le Meur
Yann
Y
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003453:Cryptococcosis / Q000150:complications* / Q000175:diagnosis; D003646:Debridement; D003937:Diagnosis, Differential; D004372:Ducks; D004781:Environmental Exposure; D005151:Facial Injuries / Q000150:complications / Q000382:microbiology; D015725:Fluconazole / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis; D010000:Osteitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D010014:Osteolysis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D010294:Parietal Bone / Q000382:microbiology / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology*; D012074:Remission Induction; D018239:Seminoma / Q000532:radiotherapy / Q000601:surgery; D012888:Skull Neoplasms / Q000175:diagnosis; D040521:Subcutaneous Tissue / Q000382:microbiology; D013736:Testicular Neoplasms / Q000532:radiotherapy / Q000601:surgery
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D000666:Amphotericin B; D015725:Fluconazole