Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
November 2017
Next Case Coming December 5...
Cryptococcoma/Neurocryptococcosis
- Background:
- Fungal infection caused by Cryptococcus neoformans or sp, usually in immunocompromised patients. Our patient was immunocompetent (no HIV or other immunocompromising diseases, no diabetes, no neoplasms).
- Hematogenous dissemination from the lungs to the CNS is the most common route of infection.
- Four basic manifestations: diffuse meningeal disease (more common), focal or multiple parenchymal lesions (common), disseminated nonfocal disease of the parenchyma (rare), focal lesion with dural base (rare)
- Clinical Presentation:
- Altered mental status/meningism, focal neurologic symptoms in an immunocompromised patient
- Focal deficits depending on the locations of the lesions
- Key Diagnostic Features:
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Imaging findings are often nonspecific and they can mimic metastasis, but the low intensity of the lesion can lead to the suspicion of a fungal etiology.
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- Differential Diagnoses:
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Neoplasms (primary or metastatic)
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Pyogenic abscess
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Granulomatous meningitis
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The leading differential consideration based on initial imaging was a neoplasm (primary or secondary). The biopsy revealed a fungal infection by Cryptococcus.
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- Treatment:
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Antifungals like Fluconazol or Amphotericin B - if unsuccessful, surgical removal.
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