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[An autopsy case with cerebral histoplasmoma: case report]
Takao Arai1, Junko Fujigasaki, Hideki Arakawa
1Department of Neurosurgery, Jikei University of Medicine, 3-26-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
No to Shinkei = Brain and Nerve
|November 24, 2004
Summary
Central nervous system (CNS) histoplasmosis is rare but can be fatal. Early diagnosis requires high clinical suspicion, especially in patients from endemic areas, to enable effective antifungal treatment.
Area of Science:
- Mycology
- Neurology
- Infectious Diseases
Background:
- Histoplasma capsulatum infection is usually asymptomatic, with disseminated disease and central nervous system (CNS) involvement being uncommon.
- CNS histoplasmosis, though rare (10-50% of disseminated cases), can be fatal or discovered incidentally at autopsy.
- Effective antifungal treatment is possible for some patients with CNS histoplasmosis.
Observation:
- A case of a 44-year-old engineering contractor presented with headache and CNS lesions mimicking malignancy.
- Radiological findings included enhancing masses in the ventricles and cisterns, leading to a presumptive diagnosis of lymphoma.
- The patient experienced rapid neurological decline and death due to cerebral infarctions.
Findings:
- Autopsy revealed disseminated histoplasmoma in the CNS, confirming a systemic infection.
- Gene analysis confirmed the diagnosis of histoplasmoma.
- The case highlights diagnostic challenges due to non-specific radiological features of CNS histoplasmoma.
Implications:
- Clinicians must consider endemic fungal infections like histoplasmosis in the differential diagnosis of CNS lesions, especially ring-enhancing ones.
- Patient history, including travel to endemic regions (e.g., Africa, Central America) and occupation, is crucial for diagnosis.
- Maintaining a high index of suspicion and thorough patient history are vital for timely diagnosis and management of CNS histoplasmosis.