Osteoarticular Cryptococcosis Successfully Treated with High-Dose Liposomal Amphotericin B Followed by Oral Fluconazole

• Main Authors: 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
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-02-01
• Series: Infection and Drug Resistance
• Subjects: cryptococcus neoformans; osteoarticular cryptococcosis; immunocompetent; liposomal amphotericin b; fluconazole desensitization
• Online Access: https://www.dovepress.com/osteoarticular-cryptococcosis-successfully-treated-with-high-dose-lipo-peer-reviewed-article-IDR

Guillem Deus,1 Silvia Gómez-Zorrilla,1 Daniel Echeverria-Esnal,2 Ana Siverio,3 Robert Güerri-Fernandez,1 Jesús Ares,4 Nuria Campillo,2 Emili Letang,1,5 Hernando Knobel,1 Santiago Grau,2 Juan Pablo Horcajada1 1Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain; 2Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; 3Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain; 4Department of Radiology, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; 5ISGlobal, Barcelona Institute for Global, Universitat de BarcelonaHealth, Barcelona, SpainCorrespondence: Silvia Gómez-ZorrillaHospital del Mar, Infectious Diseases Department, Passeig Maritim 25-29 I, Barcelona, 08003, SpainTel [phone]Fax [phone]Email [e-mail]: 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.Keywords: Cryptococcus neoformans, osteoarticular cryptococcosis, immunocompetent, liposomal amphotericin B, fluconazole desensitization