Cerebral cryptococcoma in immunocompetent patients: a series of four cases

Abstract

Introduction: Cryptococcoma is a rare CNS infection caused by Cryptococcus neoformans, with a granulomatous lesion. It’s even rarer in immunocompetent patients. Diagnosis requires histopathological analysis and treatment with amphotericin B, often with surgical resection. The aim is to report four cases of cerebral cryptococcoma In Immunocompetent Patients. This is a case report study. The information of this work was obtained through review of the medical record. Case report: We report on four cases of cerebral cryptococcoma in immunocompetent patients. All cases presented with images of expansive lesions and compatible histopathological analysis. The first case was a 62-year-old man with dysphasia and decreased strength on the right side, and underwent total surgical resection, followed by 23 days of amphotericin B treatment. The second case was a 62-year-old woman who presented with orofacial dyskinesia and decreased strength on the right side, and underwent stereotactic surgery, followed by antifungal treatment. After 10 days of hospitalization, the patient developed respiratory insufficiency, progressed to cardiorespiratory arrest and brain death. The third case was a 54-year-old woman who presented with a skin infection caused by Cryptococcus. During treatment with fluconazole, the patient experienced altered sensory perception and left hemiparesis. Surgical resection of the lesion was performed, followed by 30 days of antifungal treatment. The fourth case was a 54-year-old man who presented with pulsatile headache and right hemiparesthesia, and underwent stereotactic neurosurgery, followed by 12 days of amphotericin B treatment. Conclusion: Cryptococcus neoformans infection in the CNS, manifested in the form of cryptococcoma, although rare, should be considered as a differential diagnosis for brain expansive lesions in immunocompetent individuals.