Osteoarticular cryptococcosis successfully treated with high-dose liposomal amphotericin B followed by oral fluconazole

Deus, Guillem; Gómez-Zorrilla, Silvia; Echeverría Esnal, Daniel; Siverio-Parès, Ana; Güerri Fernández, Roberto; Ares, Jesús; Campillo Ambrós, Núria; Letang Jiménez de Anta, Emilio Ángel; Knobel Freud, Hernando; Grau Cerrato, Santiago; Horcajada Gallego, Juan Pablo

doi:http://dx.doi.org/10.2147/IDR.S294299

Osteoarticular cryptococcosis successfully treated with high-dose liposomal amphotericin B followed by oral fluconazole

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Deus G, Gómez-Zorrilla S, Echeverria-Esnal D, Siverio A, Güerri-Fernandez R, Ares J, Campillo N, Letang E, Knobel H, Grau S, Horcajada JP. Osteoarticular cryptococcosis successfully treated with high-dose liposomal amphotericin B followed by oral fluconazole. Infect Drug Resist. 2021;14:719-22. DOI: 10.2147/IDR.S294299

Abstract

Background: Skeletal involvement of Cryptococcus neoformans is infrequent and usually associated with disseminated cryptococcosis or underlying predisposing conditions. We present an atypical case of osteoarticular cryptococcosis in an immunocompetent patient. Case presentation: We herein report a case of bone and soft tissue cryptococcal infection in a 42-year-old male from Pakistan with well-controlled diabetes without other associated immunodeficiencies treated with antifungal therapy without surgical debridement. Furthermore, the patient developed toxidermia due to fluconazole use, so a fluconazole desensitization was performed. Therapeutic management also included the performance of therapeutic drug monitoring of fluconazole plasma concentrations. Conclusion: To our knowledge, this is the first case of osteoarticular cryptococcosis treated with this treatment regimen. This strategy may be of interest to try to reduce hospital stay and associated complications.