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.
Cite this paper
Minasian, T. , Hariri, O. , Corsino, C. , Miulli, D. , Farr, S. and Siddiqi, J. (2013) Isolated lumbar-4 vertebral cryptococcosis in an immunocompetent patient—A case report and literature review. Case Reports in Clinical Medicine, 2, 348-350. doi: 10.4236/crcm.2013.26094.
 Jaramillo-de la Torre, J.J., et al. (2006) Vertebral osteomyelitis. Neurosurgery Clinics of North America, 17, 339-351. doi:10.1016/j.nec.2006.05.003
 Houda, B., et al. (2011) Vertebral cryptococcosis in an immunocompetent patient—A case report. Pan African Medical Journal, 8, 42.
 Chae, H.S., et al. (2012) Rapid direct identification of Cryptococcus neoformans from pigeon droppings by nested PCR using CNLAC1 Gene. Poultry Science, 91, 1983-1989. doi:10.3382/ps.2012-02307
 Bubb, H. (1955) Cryptococcus neoformans infection in bone. South African Medical Journal, 29, 1259-1261.
 Jesse, C.H. (1947) Cryptococcus neoformans infection (torulosis) of bone; report of a case. Journal of Bone & Joint Surgery, 29, 810.
 Schiappa, D., et al. (2002) An auxotrophic pigmented Cryptococcus neoformans strain causing infection of the bone marrow. Medical Mycology, 40, 1-5.
 Bicanic, T. and Harrison, T. (2004) Cryptococcal meningitis. British Medical Bulletin, 72, 99-118.
 Mitchell, T.G. and Perfect, J.R. (1995) Cryptococcosis in the era of AIDS—100 years after the discovery of Cryptococcus neoformans. Clinical Microbiology Reviews, 8, 515-548.
 Buchanan, K. and Murphy, J. (1998) What makes Cryptococcus neoformans a pathogen. Emerging Infectious Diseases, 4, 71. doi:10.3201/eid0401.980109
 Matsushita, T. and Suzuki, K. (1985) Spastic paraparesis due to cryptococcal osteomyelitis. A case report. Clinical Orthopaedics and Related Research, 196, 279-284.
 Sehn, J. and Gilula, L. (2012) Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. European Journal of Radiology, 81, 940-946.