Pontine Cryptococcoma in a Nonimmunocompromised Individual: MRI Characteristics

Kesler, Roman; Maertens, Paul

doi:10.1111/jon199992118

Cited by 18 publications

(12 citation statements)

References 7 publications

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“…Patients were considered to have CNS cryptococcal lesions if any of the following previously reported abnormalities were found on neuroimaging studies patchy or diffuse leptomeningeal enhancement, hydrocephalus, parenchymal mass lesions or cryptococcomas, gelatinous pseudocysts, and dilation of the perivascular (Virchow-Robin) spaces (13, 15, 17, 22). Interpretation of the imaging studies was per the radiologists at each center.…”

Section: Methodsmentioning

confidence: 99%

Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings

et al. 2008

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Background Prognostic implications of cryptococcal antigen and outcomes associated with CNS cryptococcal lesions in solid organ transplant (SOT) recipients have not been fully defined. Methods Patients were derived form a cohort of 122 SOT recipients with cryptococcosis in a multicenter study from 1999–2006. Results CNS cryptococcosis was documented in 61 patients. Serum or CSF antigen titers did not correlate with mortality at 90 days or CSF sterilization at 2 weeks. CNS lesions were identified in 16 patients and included leptomeningeal lesions in 8, parenchymal lesions in 6 and hydrocephalus in 2. Overall, 13/16 CNS lesions were present at the time of diagnosis. One parenchymal and 2 hydrocephalus lesions however, developed after diagnosis and fulfilled the criteria for immune reconstitution syndrome (IRS). CSF antigen titers were higher with meningeal vs. parenchymal lesions, and hydrocephalus (p=0.015). Mortality was 50% (3/6) for patients with parenchymal, 12.5% (1/8) for those with leptomeningeal, and 0/3 for patients with hydrocephalus. Mortality was 31% (4/13) for patients with CNS lesions at baseline and 0/3 in those with new onset lesions. Conclusions Despite a greater antigen titer with meningeal lesions, outcomes tended to be worse with parenchymal compared to meningeal lesions or hydrocephalus. New onset CNS lesions may represent IRS and appeared to be associated with better outcome.

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Section: Methodsmentioning

confidence: 99%

Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings

et al. 2008

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“…Only rarely are localized organized infection in the form of parenchymal cryptoccocomas found. When present, cryptoccocomas appear as round lesions, hypointense on T1-and hyperintense on T2-weighted images, with possible subtle ring enhancement dependent on the host's immunological status [3,4]. The latter can be masqueraded as (posterior fossa) brain tumor, especially in immunoincompetent patients [5].…”

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confidence: 99%

Cryptococcal cerebellitis after chemotherapy and autologous stem cell re-infusion in a patient with multiple myeloma

et al. 2009

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“…They usually appear in the literature as case reports because of their low incidence. They are more common in immunocompetent hosts and usually have a better prognosis than disseminated cryptococcosis (17,22).…”

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confidence: 99%

First Case of Human Cryptococcosis Due to Cryptococcus neoformans var. gattii in Spain

Colom

Frasés

Ferrer³

et al. 2005

J Clin Microbiol

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We report the first case of human cryptococcosis due to Cryptococcus neoformans var. gattii described in our country, which was presented as brain cryptococcoma in an immunocompetent patient. An extensive sampling of the patient's environment was carried out to find the source of infection. CASE REPORTA 60-year-old heterosexual Spanish farmer came to the Hospital General de Alicante in July 2003, having suffered for several days from cephalalgia and somnolence. He had never traveled abroad. A diabetes mellitus type 2 identified 2 years previously was the only clinical antecedent of interest. Human immunodeficiency virus serology was investigated with repeated negative results. General and neurological exploration included computerized tomography scanning, which disclosed a brain mass lesion in basal ganglions. Capsulated yeasts were seen in a stereotaxic brain puncture sample, and Cryptococcus neoformans was suspected to be the causative agent. C. neoformans capsular antigen was detected in blood and cerebrospinal fluid (CSF) several times during the process (maximum values detected, 1/256 and 1/32, respectively). The yeast was cultured from a surgical drainage sample of the brain abscess. Species identification was carried out on the basis of microscopic morphology, growth at 37°C, a urease test, phenoloxydase production, and the carbohydrate assimilation pattern (Auxacolor; Bio-Rad). Further testing such as canavanina glycine bromothimol blue agar growth, serotype determination (Cryptocheck test; Iatron), and genotype analysis revealed that the strain was C. neoformans var. gatti serotype B. The strain identification and serotype were confirmed in another mycology laboratory (IMIM, Barcelona, Spain). Two antifungal drug sensitivity tests were performed (Sensititre and Etest). Both tests showed low amphotericin B (AMB) and ketoconazole MICs but different results with fluconazole (MIC sensititre , 8 g/ml; MIC Etest , 64 g/ml) and 5-flucytosine (MIC sensititre , 2 g/ml; MIC Etest , 32 g/ml). Voriconazole was only tested with the Sensititre test (MIC sensititre , 12 g/ml). Genotype analysis consisted of the study of five molecular DNA targets: internal transcribed spacer-5.8S rRNA gene sequence analysis (36), 5S rRNA gene and URA5 gene restriction fragment length polymorphism (RFLP) analysis (24), and amplification patterns of two highly repeated minisatellite sequences (M13 and GACA 4 ) (14, 24). Nucleotide sequence analysis of the internal transcribed spacer-5.8S rRNA gene confirmed the identification at a species level by comparing it to ribosomal sequence databases (EMBL and GenBank). RFLP of the URA5 gene showed a VGI molecular type (Fig. 1) which is characteristic of C. neoformans var. gattii. RFLP 5S rRNA gene and minisatellite amplification of M13 and GACA 4 also displayed molecular patterns attributable to C. neoformans var. gattii strains (14, 24).Some different antifungal therapies were followed, depending on the clinical evolution and the antigen levels (serum and CSF). Intravenous AMB at 200 mg/day (A...

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Pontine Cryptococcoma in a Nonimmunocompromised Individual: MRI Characteristics

Cited by 18 publications

References 7 publications

Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings

Central Nervous System Cryptococcosis in Solid Organ Transplant Recipients: Clinical Relevance of Abnormal Neuroimaging Findings

Cryptococcal cerebellitis after chemotherapy and autologous stem cell re-infusion in a patient with multiple myeloma

First Case of Human Cryptococcosis Due to Cryptococcus neoformans var. gattii in Spain

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