title: Bifocal cryptococcal osteomyelitis: management of a patient with concurrent femur and rib infections.
abstract: A case of Cryptococcus neoformans osteomyelitis involving both the femur and rib is reported. A 50-year-old male presented with a 1-month history of a persistently painful right hip. Radiography revealed an osteolytic area in the subcapital region of the right femoral neck and trochanteric region, and magnetic resonance imaging (MRI) revealed an intramedullary lesion in the peritrochanteric region. A Tc99m whole body bone scan showed significantly increased uptake in the posterior aspect of the right 7th rib as well as the right femoral region. Hemiarthroplasty with a bipolar prosthesis was performed. Because a permeative osteolytic lesion was identified intraoperatively, surgical resection was also performed. A culture from intraoperative specimens yielded C. neoformans. The rib infection was not treated surgically. Intravenous fluconazole was administered postoperatively. The patient became seronegative for cryptococcal antigen with no further illness over the next five years.
authors.affiliation: Department of Orthopedics, Kuang-Tien General Hospital and Hung Kuang University, No. 117 Shatian Road, Shalu, Taichung, Taiwan.
authors.forename: Herng-Jeng
authors.initials: HJ
authors.lastname: Jou
authors.forename: Fang-Tsai
authors.initials: FT
authors.lastname: Lee
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Wang
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Yang
authors.forename: Nai-Phon
authors.initials: NP
authors.lastname: Wang
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D003453:Cryptococcosis / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005269:Femur / Q000382:microbiology / Q000473:pathology*; D015725:Fluconazole / Q000627:therapeutic use; D006621:Hip Joint / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D012272:Ribs / Q000382:microbiology / Q000473:pathology*; D016896:Treatment Outcome; D051598:Whole Body Imaging
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole