Pyrexia of unknown origin in a healthy adult: a case report

A 23-year-old male, with no known co-morbid illnesses, presented with a history of chronic fever and left hip pain of 6-months duration. The persistence of the fever with the progressive worsening of pain despite outpatient management prompted him to seek further evaluation. He was evaluated outside on multiple occasions and was diagnosed with a left sacroiliitis with left gluteal and paraspinal fluid collection 2 months prior, for which he was initiated on empirical anti tubercular treatment (ATT). In view of worsening of symptoms, he presented to our centre where he underwent a curettage and bone grafting of the left SI joint following repeat imaging. Tissue culture grew Cryptococcus neoformans and he was started on liposomal Amphoterecin B with Flucytosine. Patient clinically improved and was discharged on the same regimen. This case report aims shed light on the evidence of primary skeletal cryptococcal infection in an immunocompetent individual.