Cerebral cryptococcoma successfully treated by isavuconazole in an immunocompetent patient: a case report

Abstract

Introduction: Cryptococcosis has been recognized as an increasing cause of severe systemic mycosis in immunocompetent patients in recent years. Radial cryptococcomas are a more uncommon manifestation of cryptococcal meningitis, which are usually not included in the differential air masses. Thus, transmission of the disease occurs by inhalation of cryptococcus spores, initially infecting the lungs. Infectious propagules may also be restricted to the central nervous system, causing cryptococcal meningitis, meningoencephalitis, and respiratory cryptococcomas. Case report: We report the case of a young immunocompetent woman who rapidly evolved with severe neurological deficits. She was finally diagnosed with cerebral cryptococcoma caused by cryptococcus neoformans and Cryptococcus gattii, and was treated with amphotericin B and isavuconazole. This is a case report on antifungal drug treatment in immunocompetent patients with cerebral cryptocoma. After several complications during hospitalization, including hydrocephalus and cerebellitis, she was discharged on isavuconazole. At follow-up, he complained only of anosmia. We reviewed the clinical and radiological findings of similar cases. It is the first time that this form of cryptococcal meningitis is favorably treated with isavuconazole and is caused by two species of Cryptococcus. Conclusion: We emphasize that respiratory cryptococcomas should be suspected in immunocompetent patients who have brain masses or whose symptoms can progress rapidly, sometimes with a lethal outcome.