Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient
Introduction: Cryptococcal infections are typically thought of as occurring in immunocompromised patients, such as patients with HIV/AIDS, solid organ transplant recipients, or patients with rheumatologic diseases that require immunomodulatory therapy. Moreover, Cryptococcus spp. classically appear...
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Elsevier
2025-01-01
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| author | Matthew Alexander Stack John-Paul Lavik Jack G. Schneider Brynne E. Cross |
| author_facet | Matthew Alexander Stack John-Paul Lavik Jack G. Schneider Brynne E. Cross |
| author_sort | Matthew Alexander Stack |
| collection | DOAJ |
| description | Introduction: Cryptococcal infections are typically thought of as occurring in immunocompromised patients, such as patients with HIV/AIDS, solid organ transplant recipients, or patients with rheumatologic diseases that require immunomodulatory therapy. Moreover, Cryptococcus spp. classically appear as variably-sized yeasts with narrow-based budding surrounded by a thick polysaccharide capsule. However, cryptococcal infections are being increasingly reported in atypical hosts, at times with non-characteristic histochemical staining appearances. Herein, we report a case of cryptococcal osteomyelitis in an otherwise immunocompetent individual that had a “speckled-egg” staining appearance on direct-smear Gram stain. Case: The patient is an otherwise healthy 89-year-old male with a past medical history notable only for hypertension who presented with progressive left-sided neck pain that became worse despite lidocaine trigger point injections; imaging was obtained and revealed a C1-C2 prevertebral abscess, C2-C4 osteomyelitis, and a small C2-C4 abscess. An aspiration biopsy from one of the cervical abscesses grew Cryptococcus neoformans. Despite prompt initiation of liposomal amphotericin B as soon as the organism was suspected, the patient’s mentation declined with associated progression of weakness in his upper and lower extremities. The patient was ultimately transitioned to comfort care. Conclusions: Unconventional presentations of cryptococcal disease are becoming increasingly recognized in seemingly immunocompetent patients. Our case was unique given that it occurred in a patient who appeared to be immunocompetent and the Gram stain showed a speckled-egg staining pattern that alone was not distinctive for cryptococcal yeasts. Despite the patient’s lack of any classic comorbidities associated with invasive cryptococcal disease, his advanced age was likely a risk factor. |
| format | Article |
| id | doaj-art-5ff4f1c38c0e473bb5fd47cdeb9aee61 |
| institution | Kabale University |
| issn | 2214-2509 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | IDCases |
| spelling | doaj-art-5ff4f1c38c0e473bb5fd47cdeb9aee612025-02-06T05:11:47ZengElsevierIDCases2214-25092025-01-0139e02171Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patientMatthew Alexander Stack0John-Paul Lavik1Jack G. Schneider2Brynne E. Cross3Division of Infectious Disease, Saint Louis University School of Medicine, Saint Louis, MO, USA; Corresponding author.Department of Pathology and Laboratory Medicine, Division of Clinical Microbiology, Indiana University Health, Indianapolis, IN, USAThe Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USAWomack Army Medical Center, Department of Pathology, Fort Liberty, NC, USAIntroduction: Cryptococcal infections are typically thought of as occurring in immunocompromised patients, such as patients with HIV/AIDS, solid organ transplant recipients, or patients with rheumatologic diseases that require immunomodulatory therapy. Moreover, Cryptococcus spp. classically appear as variably-sized yeasts with narrow-based budding surrounded by a thick polysaccharide capsule. However, cryptococcal infections are being increasingly reported in atypical hosts, at times with non-characteristic histochemical staining appearances. Herein, we report a case of cryptococcal osteomyelitis in an otherwise immunocompetent individual that had a “speckled-egg” staining appearance on direct-smear Gram stain. Case: The patient is an otherwise healthy 89-year-old male with a past medical history notable only for hypertension who presented with progressive left-sided neck pain that became worse despite lidocaine trigger point injections; imaging was obtained and revealed a C1-C2 prevertebral abscess, C2-C4 osteomyelitis, and a small C2-C4 abscess. An aspiration biopsy from one of the cervical abscesses grew Cryptococcus neoformans. Despite prompt initiation of liposomal amphotericin B as soon as the organism was suspected, the patient’s mentation declined with associated progression of weakness in his upper and lower extremities. The patient was ultimately transitioned to comfort care. Conclusions: Unconventional presentations of cryptococcal disease are becoming increasingly recognized in seemingly immunocompetent patients. Our case was unique given that it occurred in a patient who appeared to be immunocompetent and the Gram stain showed a speckled-egg staining pattern that alone was not distinctive for cryptococcal yeasts. Despite the patient’s lack of any classic comorbidities associated with invasive cryptococcal disease, his advanced age was likely a risk factor.http://www.sciencedirect.com/science/article/pii/S2214250925000265Cryptococcus neoformansHistochemical stainingCryptococcal osteomyelitisImmunocompetent |
| spellingShingle | Matthew Alexander Stack John-Paul Lavik Jack G. Schneider Brynne E. Cross Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient IDCases Cryptococcus neoformans Histochemical staining Cryptococcal osteomyelitis Immunocompetent |
| title | Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| title_full | Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| title_fullStr | Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| title_full_unstemmed | Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| title_short | Speckled-egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| title_sort | speckled egg staining appearance of cryptococcal osteomyelitis in an immunocompetent patient |
| topic | Cryptococcus neoformans Histochemical staining Cryptococcal osteomyelitis Immunocompetent |
| url | http://www.sciencedirect.com/science/article/pii/S2214250925000265 |
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