CNS Cryptococcoma in an Immunocompetent Adult from a Low Resource Setting: An Illustrative Case Report
DOI:
https://doi.org/10.47604/jhmn.2165Keywords:
Cryptococcal Meningitis, Immunocompetent Patient, UgandaAbstract
Purpose: Cryptococcal infection in the Central Nervous System (CNS) is frequently seen in human immunodeficiency virus (HIV) patients and others with low immunity. CNS cryptococcoma in immunocompetent patients is rare. We present a case of CNS cryptococcoma in an immunocompetent patient and review literature.
Methodology: A 62-year-old, HIV negative, immunocompetent female patient with no known chronic illness, presented with 5 months’ history of a progressive headache, associated with on and off episodic generalized convulsions. She had been to several hospitals before referral to our center with a diagnosis of a brain tumor on CT scan imaging. Before this and despite a negative CSF analysis result, she had received treatment for bacterial meningitis with no success.
Findings: At Mbarara Regional Referral Hospital (MRRH), she had surgery with excision biopsy which showed features consistent with cryptococcosis on histology. The patient had a successful adjuvant treatment with antifungal drugs following surgery.
Unique Contribution to Theory, Practice and Policy: The diagnosis of a CNS cryptococcal infection in an immunocompetent patient and its successful treatment by including surgery, were both unusual. Fatal postsurgical outcomes have been reported by other authors who favor a totally conservative approach to the treatment of this lesion.
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Makadzange A, McHugh G. New Approaches to the Diagnosis and Treatment of Cryptococcal Meningitis. Semin Neurol. 2014;34(01):047-060. doi:10.1055/s-0034-1372342
Góralska K, Blaszkowska J, Dzikowiec M. Neuroinfections caused by fungi. Infection. 2018;46(4):443-459. doi:10.1007/s15010-018-1152-2
Mohammadi H, Sadeghi S, Zandi S. Central nervous system aspergilloma in an immunocompetent patient: A case report. Iranian Journal of Public Health. 2015;44(6):869-872.
Santana-Ramírez A, Esparza-Gutiérrez S, Avila-Rodríguez P, Jiménez-Gómez J, Vélez-Gómez E, Bañuelos-Gallo D. Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease. Surgical Neurology International. 2016;7(40):S940-S946. doi:10.4103/2152-7806.195230
Shamim MS, Enam SA, Ali R, Anwar S. Craniocerebral aspergillosis: A review of advances in diagnosis and management. Journal of the Pakistan Medical Association. 2010;60(7):573-579.
Uppar A, Raj ARP, Konar S, et al. Intracranial Cryptococcoma—Clinicopathologic Correlation and Surgical Outcome: A Single-Institution Experience. World Neurosurgery. 2018;115:e349-e359. doi:10.1016/j.wneu.2018.04.056
Offiah CE, Naseer A. Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era. Clinical Radiology. 2016;71(1):9-17. doi:10.1016/j.crad.2015.10.005
Li Q, You C, Liu Q, Liu Y. Central nervous system cryptococcoma in immunocompetent patients: a short review illustrated by a new case. Acta Neurochir. 2010;152(1):129-136. doi:10.1007/s00701-009-0311-8
Duarte SBL, Oshima MM, Mesquita JV do A, Nascimento FBP do, Azevedo PC de, Reis F. Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras. 2017;50:359-365. doi:10.1590/0100-3984.2016.0017
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Copyright (c) 2023 David Kitya , Joseph M Ssembatya, Blessing M Taremwa , Herve M Lekuya , Josephine Najjuma , Raymond Atwine, Vallence Niyonzima, Fuller T Anthony
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