Cryptococcoma mimicking a brain tumor in an immunocompetent patient: case report of an extremely rare presentation

• Main Author: Paiva, Aline Lariessy Campos
• Publication Date: 2018
• Other Authors: Aguiar, Guilherme Brasileiro de, Lovato, Renan Maximilian, Zanetti, Arthus Vilar Deolindo, Panagopoulos, Alexandros Theodoros, Veiga, José Carlos Esteves
• Format: Article
• Language: eng
• Source: São Paulo medical journal (Online)
• Download full: https://periodicosapm.emnuvens.com.br/spmj/article/view/689
• topic: Cryptococcosis; Brain neoplasms; Meningitis, cryptococcal; Immunocompetence

CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing coun- tries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are un- common: they are described as cryptococcomas and their prevalence is even lower among immunocom- petent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infec- tions was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. CASE REPORT: A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS: Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presenta- tion in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.