Cryptococcal infection of the ribs mimicking malignant tumor: two cases report and literature review

Abstract

Abstract:

Objective To study the characteristics of cryptococcal infection of the ribs. Method Two cases of cryptococcal infection of the ribs were described and literatures were reviewed. Results Case 1:A 37-old-man with hepatitis B virus carrier was admitted to our hospital complaining of cough, phlegm with blood and right chest pain for one month. A chest CT showed the right 5^th rib destruction with adjacent lumpy soft tissue. The patient was diagnosed with cryptococcal infection of the rib by pathological examination. He received surgery and anti-fungal drug treatment for 4 months and was stable without recurrence during the 3-year follow-up period. Case 2:A 31-old-man with thrombopenia was admitted to our hospital complaining of cough, phlegm with blood for 3 months and chest pain for 2 weeks. A chest CT showed mutiple rib destructions with adjacent lumpy soft tissue in the both sides. The patient was diagnosed with cryptococcal infection of the ribs by pathological examination. He was treated with anti-fungal drug for 6 months and was stable without recurrence during the 2-year follow-up period. Conclusions Solitary cryptococcal infection of the ribs is rare, and it is easily confused with tumor, tuberculosis and other diseases. The diagnosis depends mainly on histopathological examination. The patients can be obtained satisfactory results after treatment.

Key words: Cryptococcus, bone, fluconazole, tomography,X-ray computed

CLC Number:

R519.4

HUANG Jin-bao, LAN Chang-qing, WEN Heng, LIN Qing-hua. Cryptococcal infection of the ribs mimicking malignant tumor: two cases report and literature review[J]. Chinese Journal of Mycology, 2020, 15(5): 278-282.

References 41

[1]	Nottebart HC, McGehee RF, Utz JP. Cryptococcus neoformans osteomyelitis:case report of two patients[J]. Sabouraudia,1974, 12(2):127-132.
[2]	Collins VP. Bone involvement incryptococcosis (torulosis). Am J Roentgenol, 1950, 63(1):102-112.
[3]	Wood L, Miedzinski L.Skeletal cryptococcosis:Case report and review of the literature[J]. Can J Infect Dis. 1996, 7(2):125-132.
[4]	Zhou HX, Ning GZ, Feng SQ,et al. Cryptococcosis of lumbar vertebra in a patient with rheumatoid arthritis andscleroderma:case report and literature review[J]. BMC Infect Dis, 2013, 13:128.
[5]	聂苗苗,钟群,吴小伟,等. 肋骨隐球菌病1例[J]. 实用放射学杂志, 2014,30(3):535-536.
[6]	Sethi S. Cryptococcal osteomyelitis in the ribs[J]. J Glob Infect Dis, 2010, 2(1):63-64.
[7]	Chang WC, Tzao C, Hsu HH, et al. Isolated cryptococcal thoracic empyema with osteomyelitis of the rib in animmunocompetent host[J]. J Infect 2005;51(3):e117-119.
[8]	Lie KW, Yu YL, Cheng IK, et al. Cryptococcal infection of the lumbar spine[J]. J R Soc Med, 1989,82(3):172-173.
[9]	Amit A, Sudish K, Pople IK. Primary calvarial cryptococcal osteomyelitis in a patient with idiopathiclymphopenia[J]. Acta Neurochir (Wien). 2008, 150(7):713-714.
[10]	Chleboun J, Nade S. Skeletal cryptococcosis[J]. J Bone Joint Surg Am, 1977, 59(4):509-514.
[11]	Hajjeh RA, Conn LA, Stephens DS, et al. Cryptococcosis:population-based multistate active surveillance and risk factorsin human immunodeficiency virus-infected persons[J]. Cryptococcal Active Surveillance Group. J Infect Dis, 1999,179(2):449-454.
[12]	Jarvis JN, Harrison TS. Pulmonary cryptococcosis[J].Semin Respir Crit Care Med, 2008, 29(2):141-150.
[13]	邓德权, 桑红, 李杰, 等. 新生隐球菌致头皮和颅骨损害1例报道[J]. 医学研究生学报, 2010, 23(11):1132-1135.
[14]	邝俊健,吴丽明. 对1例左胫腓骨骨折术后指甲隐球菌感染患者的药学监护[J]. 中国药物应用与监测, 2011, 8(1):32-34.
[15]	Armonda RA, Fleckenstein JM, Brandvold B, et al. Cryptococcal skull infection:a case report with review of the literature[J]. Neurosurgery, 1993, 32(6):1034-1036.
[16]	朱振祥,陆增珏. 右肱骨隐球菌病一例[J]. 临床放射学杂志, 2000, 19(1):66.
[17]	王刚祥, 张正初, 徐宏宇. 右股骨新型隐球菌感染1例[J].中国骨伤, 2005, 18(6):379.
[18]	袁敏, 杨继金. 胸椎隐球菌病一例[J]. 中华放射学杂志, 2003, 37(11):984.
[19]	李新文, 宋英儒, 黄仲奎. 股骨慢性隐球菌性骨髓炎1例[J]. 实用放射学杂志, 2007, 23(6):733, 746.
[20]	白红莲,谢俊强.隐球菌性脑膜炎并骨损害1例报告[J].临床神经病学杂志, 2001,14(2):87.
[21]	刘玲,杨于嘉, 尹飞,等. 疑难病研究-全身性播散性隐球菌病[J]. 中国当代儿科杂志, 2004, 6(3):216-218.
[22]	Chen J, Liu S, Xiong Z, et al. Cryptococcal infection of the femoral bone similar with pathologic features ofvascular tumors:a case report and review of literature[J]. Int J Clin Exp Pathol, 2015, 8(7):8551-8554.
[23]	Joo HS, Ha JK, Hwang CJ, et al. Lumbar cryptococcal osteomyelitis mimicking metastatic tumor[J]. Asian Spine J, 2015, 9(5):798-802.
[24]	陆珍芳.多发肋骨隐球菌感染1例[J].临床肺科杂志, 2019, 24(5):969-970.
[25]	Kromminga R, Staib F, Thalmann U, et al.Osteomyelitis due to Cryptococcus neoformans in advanced age. Case report and review of literature[J]. Mycoses,1990, 33(4):157-166.
[26]	杨建均, 卢青华, 刘运荣, 等. 前臂骨与软组织隐球菌病一例[J].中华病理学杂志, 2016, 45(1):55-56.
[27]	屈满英, 蒋之, 万轲. 特殊隐球菌病一例诊治分析及文献复习[J]. 医学临床研究, 2015, 32(2):345-347.
[28]	刘珍琼, 熊国亮, 辛茶香. LA检测隐球菌荚膜多糖抗原在隐球菌性脑膜炎诊断中的应用[J]. 实验与检验医学, 2013, 31(5):446-447.
[29]	付雅捷, 杨青. 隐球菌荚膜多糖抗原胶体金法在肺隐球菌病诊断中的应用[J]. 预防医学, 2017, 29(5):539-540.
[30]	胡群,徐礼裕,张雷,等. 血胶体金免疫层析法对非人免疫缺陷病毒感染的肺隐球菌病患者的诊断价值[J].中华结核和呼吸杂志, 2018, 41(8):651-653.
[31]	史会连, 陈澍, 蒋卫民, 等.以反复多发脓肿为表现的播散型隐球菌病1例[J].中国真菌学杂志, 2010, 5(5):291-293.
[32]	杨凌婧, 范红. 艾滋病马尔尼菲青霉菌感染研究进展[J]. 实用医院临床杂志, 2015, 12(5):245-247.
[33]	张建全, 柳广南, 杨美玲, 等. 马尔尼菲青霉病并发溶骨性破坏八例临床分析[J].中华临床医师杂志(电子版), 2011, 5(13):3912-3915.
[34]	孙泽勇, 韦有永, 黄文坛, 等. 进行性播散型组织胞浆菌病骨损害99Tcm-MDP骨显像一例[J].中华核医学与分子影像杂志, 2018, 38(2):118-120.
[35]	《中国真菌学杂志》编辑委员会. 隐球菌感染诊治专家共识[J]. 中国真菌学杂志, 2010, 5(2):65-68,86.
[36]	周颖杰, 李光辉. 隐球菌病处理临床实践指南:2010年美国感染病学会更新[J]. 中国感染与化疗杂志, 2010, 10(3):161-166.
[37]	Saag MS, Graybill RJ, Larsen RA, et al. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America[J]. Clin Infect Dis, 2000, 30(4):710-718.
[38]	Gupta SK, Chhabra R, Sharma BS, et al. Vertebral cryptococcosis simulating tuberculosis[J]. Br J Neurosurg, 2003,17(6):556-559.
[39]	Plummer NS, Symmers WS, Winner HI. Sarcoidosis in identical twins; with torulosis as a complication in one case[J]. Br Med J, 1957, 2(5045):599-603.
[40]	Reinig JW, Hungerford GD, Mohrmann ME, et al.Case report 268. Diagnosis:cryptococcal osteomyelitis of the calvaria[J]. Skeletal Radiol, 1984, 11(3):221-223.
[41]	Balasubramaniam P, Silva JF. Case of cryptoccosis of spine[J]. Br Med J, 1973,2(5857):27-28.