Cerebellar cryptococcosis characterized by a space-occupying lesion in an immunocompetent non-HIV patient

Middle cerebral artery infarction, A rare complication of intracranial cryptococcoma in an immunocompetent patient: A case report and literature review

Background

This report presents the first case of intracranial cryptococcoma arising from the right frontal lobe causing right middle cerebral artery infarction. Intracranial cryptococcomas usually occur in the cerebral parenchyma, basal ganglia, cerebellum, pons, thalamus, and choroid plexus; they may mimic intracranial tumors, but seldom cause infarction. Of the 15 cases of pathology-confirmed intracranial cryptococcomas in the literature, no case has been complicated by middle cerebral artery (MCA) infarction. Here, we discuss a case of intracranial cryptococcoma with an ipsilateral middle cerebral artery infarction.

Case Description

A 40-year-old man was referred to our emergency room due to progressive headaches and acute left hemiplegia. The patient was a construction worker with no history of avian contact, recent travel, or human immunodeficiency virus (HIV) infection. Brain computed tomography (CT) showed an intra-axial mass, and subsequent magnetic resonance imaging (MRI) delineated a large mass of 53 mm in the right middle frontal lobe and a small lesion of 18 mm in the right caudate head, with marginal enhancement and central necrosis. A neurosurgeon was consulted in view of the intracranial lesion, and the patient underwent en-bloc excision of the solid mass. The pathology report later identified a Cryptococcus infection rather than malignancy. The patient underwent 4 weeks of postoperative treatment with amphotericin B plus flucytosine; he then received subsequent oral antifungal treatment for 6 months, and had neurologic sequelae that manifested as left side hemiplegia.

Conclusion

Diagnosis of fungal infections in the CNS remains challenging. This is especially true of Cryptococcus CNS infections that present as a space-occupying lesion in an immunocompetent patient. A Cryptococcus infection should be considered in the differential diagnoses in patients with brain mass lesions, as this infection can be misdiagnosed as a brain tumor.

Cerebellar Cryptococcal Abscess in HIV-Negative Patient: A Case Report and Literature Review

BACKGROUND:

Cryptococcus is a common cause of opportunistic infection in HIV-positive patients. While the incidence of this disease has decreased in AIDS-associated cases, cryptococcal infection in immune-competent person has been increased.

CASE PRESENTATION:

We report a case of cryptococcosis and literature review of pathogenesis and clinical aspects of cryptococcal central nervous system infection. A 64-year-old man, from Flores, complaining of severe headache since a few days before admitted to hospital. Head MRI showed multiple hypointense lesions in the left cerebellar hemisphere, suspected abscess or metastatic process. HIV testing was non-reactive. Surgery was performed, and microscopic evaluation revealed multiple abscesses containing PAS-positive budding yeasts consistent with cryptococcal abscesses.

CONCLUSION:

Cryptococcosis rarely occur in immunocompetent patients. The clinical manifestation depends on pathogenic factors of pathogen and host factor. Treatment is with the administration of antifungal drugs, and the prognosis mostly depends on the underlying disease.

Cryptococcal cerebellitis in no-VIH patient

INTRODUCTION

Cryptococcosis is an opportunistic fungal infection whose etiology is Cryptococcus neofromans / C. gattii, complex which affects immunocompromised patients mainly. Meningeal infection is one of the most common presentations, but cerebellar affection is rare.

CASE DESCRIPTION

Male patient with 65 old years, from an area of subtropical climate with chronic exposure to poultry, without pathological antecedents, who presented clinical picture consistent with headache, fever, seizures and altered mental status.

CLINICAL FINDINGS AND DIAGNOSTIC METHODS

Initially without menigeal signs or intracranial hypertension and normal neurological examination. Later, the patient developed ataxia, dysdiadochokinesia and limb loss. By lumbar punction and image of nuclear magnetic resonance (NMR) cerebellitis cryptococcal was diagnosticated.

TREATMENT

Antifungal therapy with amphotericin B and fluconazole was performed, however the patient died.

CLINICAL RELEVANCE

The cryptococcosis has different presentations, it´s a disease whose incidence has been increasing since the advent of the HIV / AIDS pandemy, however the commitment of the encephalic parenchyma and in particular the cerebellum is considered rare. In this way we are facing the first case of cryptococcal cerebellitis in our midst.