Isolated lumbar-4 vertebral cryptococcosis in an immunocompetent patient—A case report and literature review

Tanya Minasian, Omid R. Hariri, Casey Corsino, Dan E. Miulli, Saman Farr, Javed Siddiqi

Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, USA; Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA.
Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, USA; Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA Department of Neurosurgery, Riverside County Regional Medical Center, Moreno Valley, USA Department of Neurosurgery, Institute of Clinical Orthopaedics & Neurosciences, Desert Regional Medical Center, Palm Springs, USA.
Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, USA; Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA Department of Neurosurgery, Riverside County Regional Medical Center, Moreno Valley, USA Department of Neurosurgery, Institute of Clinical Orthopaedics & Neurosciences, Desert Regional Medical Center, Palm Springs, USA Department of Neurosurgery, Kaiser Permenante Medical Center, Fontana, USA.
Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA.

DOI: 10.4236/crcm.2013.26094                

Abstract

Background: The purpose of this case report is to present an unusual and unique case of vertebral osteomyelitis due to the organism Cryptococcus neoformans, which was found to be isolated to the fourth lumbar vertebra in an immunocompetent patient. Cryptotoccus neoformans is an encapsulated yeast which typically presents in severely immunocompromised patients. Vertebral osteomyelitis is most commonly associated with bacterial infections. Case Description: A 51-year-old male presented with severe pain localized to the lumbar region, and a high grade fever for 15 days, chills, urinary hesitancy, dysuria, and fatigue. The patient’s only past medical history included Type II Diabetes Mellitus. Neoplasms and HIV were ruled out. No source of entry was located upon examination and the lungs were negative for the presence of Cryptococcal pathogen. The CT scan revealed a lytic lesion located in the fourth lumbar vertebral body. A bone biopsy confirmed the presence of Cryptococcus neoformans as the source of infection. A follow up visit was also conducted to examine the patient’s status of infection, and for the presence of complications. Conclusion: At this time, it is important to note Cryptococcus neoformans can be isolated to a single vertebral level. This case study is pivotal in demonstrating the importance of the comprehension of rare, and non-traumatic Cryptococcal infections in Central Nervous System, showing also that immunocompetent patients are well at risk for this infectious process.

Keywords

Vertebral Osteomyelitis; Cryptococcus; Immunocompetent; Lytic Lesion; Isolated Infection

Conflicts of Interest

The authors declare no conflicts of interest.

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