title: [Cryptococcal osteomyelitis in a patient with a lymphocytic leukemia treated with fludarabine-cyclophosphamide-rituximab].
abstract: BACKGROUND
  Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms.
  
  
  METHODS
  A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed.
  
  
  CONCLUSIONS
  Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement.
authors: Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Dron, rue du Président-Coty, 59208 Tourcoing, France. et_nico@yahoo.fr
authors: N
authors: N
authors: Ettahar
authors: L
authors: L
authors: Legout
authors: F
authors: F
authors: Ajana
authors: P
authors: P
authors: Patoz
authors: M
authors: M
authors: Massongo
authors: C
authors: C
authors: Rose
authors: E
authors: E
authors: Senneville
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D017577:Cutaneous Fistula / Q000209:etiology / Q000382:microbiology; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy*; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D010014:Osteolysis / Q000209:etiology; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D000069283:Rituximab; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine