Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Hagan, José E.; Dias, Jesângeli Sousa; Bisneto, Jose Villasboas; Falcão, Melissa Barreto; Ko, Albert I.; Ribeiro, Guilherme S.

doi:10.1590/0037-8682-0215-2013

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…4,[9][10][11][12][13][14][15][16][17][18][19] Surgical excision and debulking are indicated as adjunct therapies for lesions that are greater than or equal to 3 cm. 11,20 The type of neurological manifestation and the findings from neuroimaging depend on the patient's immunological status.…”

Section: Case Reportmentioning

confidence: 99%

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

et al. 2017

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CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing countries 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 uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent 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 infections 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 presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.

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Section: Case Reportmentioning

confidence: 99%

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

et al. 2017

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“…Hagan JE, et al reported a patient with cryptococcoma received dexamethasone before surgery because the lesion was mistaken for glioma initially. Corticotherapy led to some improvement, but after the diagnosis was confirmed dexamethasone was soon suspended [11]. We assume temporary clinical and radiological alleviation may result from anti-inflammatory and anti-edematous effect of corticosteroids.…”

Section: Discussionmentioning

confidence: 86%

Central nervous system Cryptococcoma mimicking demyelinating disease: a case report

Jie

Zhang

2020

BMC Neurol

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Background: Cerebral cryptococcomas is a rare form of central nervous system cryptococcosis. Most previous cases were mistaken for neoplasm before surgery. We present a case of cerebral cryptococcomas whose radiological profiles resembled demyelinating disease, especially tumefactive demyelinating lesion. Case presentation: A 40-year-old male was admitted for 1-week-long unconsciousness. Brain MRI revealed a rim-enhanced mass within the corpus callosum body. Central nervous system demyelinating disease was suspected. Empirical corticosteroid treatment led to some improvement, but his condition deteriorated 2 months later. Brain MRI revealed punctate new foci. Cryptococcus neoformans was detected in cerebrospinal fluid. Cryptococcus antigen test was positive in his current and previous cerebrospinal fluid samples. The patient died despite standard antifungal treatment. Conclusion: Diagnosis of cerebral cryptococcomas is challenging. It may mimic demyelinating diseases.

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“…However, even immunocompetent patients can be affected by CNS cryptococcosis, with high levels of mortality [5]. Pregnant women have been one group of patients affected by cryptococcosis, not only in CNS [8,9,[12][13][14] but also as cryptococcal pneumonia [15] or osteomyelitis [16].…”

Section: Discussionmentioning

confidence: 99%

“…However, in developing countries where these antifungal therapies are not available, high-dose monotherapy fluconazole is also an option to be considered [11], probably due to its good penetration in the brain parenchyma [21]. In addition, it has also been reported that a woman diagnosed with cryptococcoma in the immediate postpartum period, with intolerance to amphotericin (body rash and severe hypokalemia and hypomagnesemia with ventricular arrhythmia), was also successfully treated with high-dose fluconazole monotherapy [12]. Fortunately, pregnant women who are correctly diagnosed and treated usually have a favorable prognosis, with no consequences to the fetus [8,14].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis in an HIV-Negative Puerperal Woman

Nunes

Pires

Alves

et al. 2021

Case Reports in Infectious Diseases

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Cryptococcal meningitis is a common opportunistic infection in HIV-infected patients and other immunocompromised people. Pregnancy, which is a state of relative immunosuppression, can also be a risk factor for the development of cryptococcal meningitis. We report a clinical case of a 41-year-old woman who developed a severe meningeal syndrome after an otherwise normal pregnancy. Cerebrospinal fluid (CSF) cytochemical analysis presented hypoglycorrhachia, high protein levels, and pleocytosis. Cryptococcal antigen tested positive in serum and CSF, and Cryptococcus neoformans was identified in the CSF culture. The diagnosis of cryptococcal meningitis was confirmed, and antifungal induction therapy was started with liposomal amphotericin B and flucytosine. After clinical improvement, induction therapy was discontinued, and the patient was discharged under maintenance therapy with fluconazole. While under antifungal maintenance therapy, the patient presented worsening of symptoms and a new brain magnetic resonance showed the development of multiple cryptococcoma. Despite sterile CSF cultures, there was a deterioration of the cytochemical parameters. The diagnosis of immune reconstitution inflammatory syndrome was assumed, and after initiation of corticotherapy, the patient improved considerably. This is a rare case of cryptococcal meningitis in a puerperal woman with a challenging management.

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Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cited by 11 publications

References 12 publications

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

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

Central nervous system Cryptococcoma mimicking demyelinating disease: a case report

Cryptococcal Meningitis in an HIV-Negative Puerperal Woman

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