Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India

Abstract

Introduction: Cryptococcus gattii is an emerging global pathogen. Recent reports suggest that C. gattii cryptococcosis is more common in immunocompetent as well as HIV-infected patients than earlier estimated. We report the first case of cerebellar cryptococcoma from India due to C. gattii in an immunocompetent individual.Case Presentation: A 73-year-old immunocompetent male, presented with a 3 month history of severe headache, neck stiffness, walking difficulty, bilateral papilloedema and slight cerebellar signs including gait imbalance and giddiness. Magnetic resonance imaging (MRI) revealed a well-defined enhancing lesion in the cerebellum, suggestive of abscess and mild hydrocephalus. Blood parameters and liver function tests were within normal limits. The patient underwent paramedian suboccipital craniotomy, and the aspirated purulent material grew Cryptococcus neoformans. Histologically, the lesion was a cryptococcoma. The isolate was further identified as C. gattii VGI, serotype C, mating type alpha, and produced extracellular phospholipase enzyme. It was sensitive to amphotericin B, 5-flucytosine and azoles. The patient was treated with intravenous amphotericin B (0.7 mg kg -1 day -1 ) for 15 days along with a maintenance dose of oral fluconazole (400 mg day -1 ) for 6 months. The patient's symptoms recovered while on treatment but he was lost to follow up. Conclusion:Cryptococcus gattii is an emerging pathogen in India that affects otherwise healthy, immunocompetent individuals and requires rapid identification and treatment in order to prevent severe neurological sequelae.

Cerebelitis criptococócica en paciente VIH negativo

“…The clinical presentation of this case differs, due to the absence of cryptococomas, which are solid lesions, mainly located in basal ganglia or cerebral white matter, corresponding to abscesses or granulomas, which can be detected by NMR; 12 , neoplasms of the central nervous system 13 , brain abscesses 14 and even tuberculomas 15 with diagnostic histopathological examination after surgical management.…”

“…La presentación clínica de este caso difiere, por la ausencia de criptococomas, que son lesiones sólidas, localizados principalmente en ganglios basales o sustancia blanca cerebral, que corresponden a abscesos o granulomas, que pueden detectarse por RMN; en algunos casos se plantearon diagnósticos diferenciales como malformaciones vasculares 12 , neoplasias del sistema nervioso central 13 , abscesos cerebrales 14 e incluso tuberculomas 15 con diagnostico al examen histopatológico posterior al manejo quirúrgico.…”

Cerebellar Cryptococcal Abscess in HIV-Negative Patient: A Case Report and Literature Review

“…Meanwhile, cerebellar infection is rare. Several cases of cerebellar cryptococcosis have been reported [6], [7], [8], [9], [10], [11], [12]. The clinical manifestations of cerebellar cryptococcosis is commonly present with signs of increased intracranial pressure and abnormality of cerebellar functions (ataxia and dysdiadochokinesis).…”