Skull Cryptococcal Osteomyelitis Complicated with Pulmonary Tuberculosis

概要

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A rare case of bone cryptococcosis solely involving the skull is presented. A 63-year-old man had received an antituberculous treatment for pulmonary tuberculosis. His initial symptom was a headache that was followed by a development of slow growing elastic soft mass in the right parietal region. CT scan showed a well-circumscribed smooth margined mass in the parietal bone associated with osteo lytic changes. On aspiration biopsy an abscess containing abundant Cryptococcus neoformans was observed. He was treated with drainage and irrigation of abscess and craniectomy of the right parietal bone. He also received 200mg of oral fluconazole. About half of the patients with skeletal cryptococcosis have underlying diseases that cause abnormalities of cellular immunity (e.g., lymphoma, leukemia, sarcoidosis, TB etc), or are receiving therapies that affect cell mediated immunity (e.g., a long-term steroid therapy). It is assumed that his cell-mediated immunity was decreased because of his low lymphocyte value and his underlying disease. Clinical and radiological manifestations of bone cryptococcosis are non-specific. It should be included in the differential diagnosis, especially in the patients with bone abscess who has underlying diseases.
長崎大学の論文