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[Cryptococcus Neoformans Var. Gattii meningoencephalitis with cryptococcoma in an immunocompetent patient
Taku Inada1, Hirotoshi Imamura, Michi Kawamoto
1Department of Neurosurgery, Kobe City Medical Center General Hospital.
Abstract:
Cryptococcosis is a fungal infection, which mainly invades the lungs and central nervous system. In Japan, most cases of cryptococcosis are caused by Cryptococcus neoformans(C. neoformans). Until now, only three cases which the infectious agent was Cryptococcus neoformans var. gattii(C. gattii)have been reported. As compared with cryptococcosis caused by C. neoformans, which is often observed in immunocompromised hosts, cryptococcosis caused by C. gattii occurs predominantly in immunocompetent hosts and is resistant to antifungal drugs. Here, we report a case of refractory cerebral cryptococcoma that was successfully treated by surgical resection of the lesions. A 33-year-old man with no medical history complained of headache, hearing disturbance, and irritability. Pulmonary CT showed a nodular lesion in the left lung. Cerebrospinal fluid examination with Indian ink indicated cryptococcal meningitis, and PCR confirmed infection with C. gattii. C. gattii is usually seen in the tropics and subtropics. Since this patient imported trees and soils from abroad to feed stag beetles, parasite or fungal infection was, as such, suspected. Although he received 2 years of intravenous and intraventricular antifungal treatment, brain cryptococcomas were formed and gradually increased. Because of the refractory clinical course, the patient underwent surgical resection of the cerebral lesions. With continuation of antifungal drugs for 6 months after the surgeries, Cryptococcus could not be cultured from cerebrospinal fluid, and no lesions were seen on MR images. If cerebral cryptococcosis responds poorly to antifungal agents, surgical treatment of the cerebral lesion should be considered.
Insights
Cryptococcosis caused by Cryptococcus gattii (C. gattii) can be refractory to antifungal drugs. Surgical resection of cerebral lesions offers a successful treatment option for refractory cases, even in immunocompetent patients.
Area of Science:
- Mycology
- Infectious Diseases
- Neurosurgery
Background:
- Cryptococcosis is a significant fungal infection primarily affecting the lungs and central nervous system.
- While Cryptococcus neoformans (C. neoformans) is the predominant cause in Japan, Cryptococcus gattii (C. gattii) infections are rare but notable.
- C. gattii infections typically occur in immunocompetent individuals and exhibit resistance to standard antifungal therapies.
Observation:
- A 33-year-old immunocompetent male presented with symptoms of headache, hearing disturbance, and irritability.
- Pulmonary CT revealed a lung nodule, and cerebrospinal fluid analysis confirmed cryptococcal meningitis caused by C. gattii.
- Despite two years of intensive antifungal treatment, the patient developed refractory cerebral cryptococcomas.
Findings:
- Surgical resection of the cerebral cryptococcomas was performed due to the refractory nature of the infection.
- Following surgery and continued antifungal therapy, C. gattii was no longer culturable from cerebrospinal fluid, and imaging showed no residual lesions.
- This case highlights a successful outcome using surgical intervention for a treatment-resistant cerebral cryptococcoma.
Implications:
- Cerebral cryptococcomas caused by C. gattii can be challenging to treat with antifungal agents alone.
- Surgical resection should be considered as a viable therapeutic strategy for refractory cerebral cryptococcosis.
- This approach may offer a crucial alternative for patients unresponsive to conventional medical management, particularly in cases involving C. gattii.
