Cryptococcal infection presenting as soft tissue abscess and arthritis: Case report

RATIONALE: Cryptococcal infection has been documented in immunocompromised patients. AIDS and renal transplant recipients account for majority of the cases. Most cases present with central nervous system or disseminated disease, with only few presenting soft tissue, bone, and joint manifestations. PATIENT CONCERNS: We present a case of soft tissue mass in a 66-year-old female renal transplant recipient and that of arthritis in a 64-year-old immunocompetent man who presented pseudogout arthropathy. Chest radiographies of both cases were negative. Biopsy revealed cryptococcal organisms. Blood culture or cerebrospinal fluid sampling indicated positive results for cryptococcal antigen. DIAGNOSIS: Cryptococcus neoformans was recovered in the wound culture. INTERVENTIONS: The patients received intravenous fluconazole and flucytosine, followed by oral fluconazole administration. OUTCOMES: Symptomatic improvements were achieved and no subsequent relapses were observed. LESSONS: The authors experienced 2 cases of cryptococcosis with very unusual clinical presentation. Early clinical suspicion and serum cryptococcal antigen testing can help in rapid appropriate diagnosis in immunocompetent as well as immunocompromised patients even in the absence of pulmonary involvement.