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Requests for reprints should be addressed to Dimitrios P. Kontoyiannis, MD, ScD, PhD (Hon), FACP, FIDSA, FECMM, FAAM, FAAAS, Robert C. Hickey Chair in Clinical Care, Deputy Head, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030.
A 77-year-old patient with multiple myeloma and on lenalidomide developed a slowly
progressive right upper thigh pain with no antecedent trauma. The status of his multiple
myeloma was stable, and he did not have a history of osteolytic lesions. He had not
received corticosteroids as part of his multiple myeloma therapy. He was found to
have a right proximal femur lytic lesion (Figure 1) and received local radiation therapy for 2 months; however, the lytic lesion increased
in size, associated with worsening pain and affecting his mobility and ability to
carry his daily activities. Positron emission tomography-computed tomography (PET-CT)
showed a right proximal femoral diaphysis lesion with cortical destruction and intensely
avid fluorodeoxyglucose (FDG) uptake. He presented for an elective intramedullary
nail insertion to prevent a pathological fracture. He used to work in construction
for more than 50 years and had spent most of his life in Kentucky. He is currently
retired in Florida and plays golf in his spare time. His vital signs were normal,
and his physical examination and baseline preoperative labs were unremarkable.
First description of oral Cryptococcus neoformans causing osteomyelitis of the mandible, manubrium and third rib with associated soft tissue abscesses in an immunocompetent host.
