SA Orthopaedic Journal
Print version ISSN 1681-150X
MCGUIRE, DT; BICK, SM; WESTGARTH-TAYLOR, T and HOFFMAN, E. Cryptococcoma of the ilium in an immuno-competent child - a case report and review of the literature. SA orthop. j. [online]. 2011, vol.10, n.2, pp. 74-77. ISSN 1681-150X.
Cryptococcosis is a systemic disease caused by the fungus Cryptococcus neoformans which predominantly affects immuno-compromised individuals. Cryptococcal osteomyelitis is rare, having an incidence of 5-10% in patients with systemic cryptococcosis. Isolated cryptococcoma of bone is even less common, especially in immuno-competent individuals. We report a case of a 10-year-old girl who presented with a mass over her left iliac crest. Radiographs showed a lytic lesion of the ilium. Open biopsy and surgical curettage of the lesion was done. Histology showed a cryptococcoma. The patient was treated with fluconazole. After three months of treatment she required a repeat curettage of the lesion due to wound drainage and persistent soft tissue swelling. She continued with oral fluconazole treatment and after 7 months the wound had healed, the soft tissue swelling had resolved and radiographs showed resolution of the lesion. Fungal infections should be included in the differential diagnosis of lytic bone lesions. Tissue diagnosis should be obtained to confirm diagnosis. Fluconazole is an effective treatment for cryptococcal osteomyelitis, with surgical curettage a useful adjunct. Good results can be expected in the majority of cases.
Keywords : cryptococcosis; fungus; Aids; bone involvement.