Combined Intra- and Extracranial Cryptococcal Infection of a 20-Year-Old Patient in Right Temporal Area

Fungal disease in the head and neck area caused by saprophytic Cryptococcus neoformans is a rare condition in immunocompetent patients. However, patients with acquired immunodeficiency syndrome, leukemia, or Hodgkin’s lymphoma are at a high risk of developing serious life-threatening diseases with meningitis and pulmonary involvement. A 20-year-old man with a history of acute lymphatic leukemia and sarcoidosis presented with a 3-month history of a painful swelling in the right temporal region. Initially, removal of the third molar was performed, which did not alleviate the symptoms. After having consulted different medical services, the patient was referred to the craniomaxillofacial surgery department. A computed tomography scan revealed a right temporal soft tissue swelling with a hypodense central area and a defect in the temporal bone. After 2 incisions on the basis of a diagnosis of a temporal abscess had been performed without any improvement, a biopsy and additional microbiologic examination were initiated. The histologic and microbiologic workup confirmed the diagnosis of cryptococcosis. Fluconazole was administered for several months and all signs and symptoms of the infection resolved. The workup of the present case emphasizes the importance of the preservation of sufficient material for microbiologic examination in atypical cases of infections in the head and neck area.