Cryptococcal Osteomyelitis Complicating Intestinal Lymphangiectasia

Abstract

We report the first documented case of cryptococcal skeletal infection associated with intestinal lymphangiectasia (IL). This poorly recognized form of protein-losing enteropathy results in a loss of lymph with leakage of immunoglobulins and/or lymphocytes into the gut. This leads to the depletion of primarily naive CD4+ T cells, leaving the patient with impaired T-cell function. An esophagogastroduodenoscopy and small-bowel biopsy are often needed for diagnosis. Multiple case reports have documented the onset of cryptococcal infection in human immunodeficiency virus-negative patients with idiopathic T-cell deficiency. We assert that IL may be responsible for a considerable number of cases of invasive cryptococcal disease in patients with CD4+ T-cell lymphopenia in whom no other source of immunodeficiency has been identified. We also discuss skeletal involvement in disseminated cryptococcal infection and review the cases of cryptococcal disease and IL in the English language literature.