Cryptococcal Abscess Imitating a Soft-Tissue Sarcoma in an Immunocompetent Host

Abstract

Cryptococcus neoformans is a ubiquitous encapsulated yeast found throughout the world. Although it is only occasionally a pathogen in immunocompetent hosts, it emerged in the 1980s as an important opportunistic infection in patients with acquired immunodeficiency syndrome. Infection typically begins in the lungs and can disseminate, causing central nervous system dysfunction, cutaneous manifestations, and, occasionally, osteomyelitis in up to 10% of cases1,2. Noncutaneous cryptococcal abscesses in an immunocompetent host are exceedingly rare, and, to our knowledge, a soft-tissue cryptococcal abscess in an immunocompetent host has not been previously reported. We present the successful treatment of an isolated cryptococcal abscess, initially thought to be a soft-tissue sarcoma, in an immunocompetent host. The case of our patient adds to the current treatment literature and highlights the importance of having a tissue diagnosis prior to surgical intervention. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-six-year-old man who was otherwise healthy was seen in the orthopaedic oncology clinic because of a mass in the proximal aspect of the right thigh. This mass was first noticed six weeks prior to his evaluation, when he experienced “pressure” in this area while cycling. Thinking this was likely a musculoskeletal injury, his primary care physician initially treated him conservatively. As the mass slowly enlarged, concern for a primary oncologic process was raised. The patient reported no functional limitation, no pain, and denied having any fevers, chills, puncture wounds, or other trauma to this area. Medically, he reported only a remote history of depression and an uncomplicated appendectomy thirty years previously. He reported that he took no medication and had no drug allergy. He did not smoke or use intravenous drugs, and he denied having previous transfusions. He consumed alcohol socially and reported a …