Skeletal Cryptococcosis (Torulosis)

Report of a Case and Review of the Literature

¹ Campbell Foundation, The Division of Pathology and Microbiology, University of Tennessee, and the City of Memphis Hospitals, Memphis

The prognosis for patients in whom skeletal cryptococcosis is associated with "generalized" or meningeal involvement is poor, and there have been no recorded survivals of such patients in spite of therapy. In contrast to the fatal results in this group, however, the results in patients with localized bone disease have been good; these patients have all been well at the time their cases were reported. Table II lists these cases, describing the bones involved and the therapy employed. It is interesting to note that in all but two of these cases surgical extirpation of the disease locally was performed with apparently good results. In the case presented by Leopold cryptococcal infection of the talus and carpus was further complicated by the presence of pulmonary moniliasis. The patient in this case received vaccine therapy, but local excision of the diseased bone was not performed. The bone lesions apparently healed, but no change occurred in the pulmonary lesions. In the authors' case the clavicular lesion was treated by local curettement while the radial lesion was left untouched. Both lesions healed satisfactorily, but an analysis of the cause of this satisfactory outcome was clouded by the fact that several antibiotic and chemotherapeutic agents had been used.

After reviewing this small series of cases, the authors feel that the prognosis for patients with localized bone lesions is good regardless of the therapy employed. They also feel, however, that surgical removal of the diseased bone will enhanced healing and will lessen the possibility of dissemination of the disease.

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