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Recurring Multicentric Granulomatous Cryptococcomas in the Contralateral Cerebral Hemisphere in an Adult
Adrian Kelly1, Patrick Lekgwara1, Deon Otto1
1Department of Neurosurgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health, Sciences University, Pretoria, South Africa.
Background:
Fungal mass lesions in the central nervous system rarely reach a size large enough to directly cause neurologic deterioration. In terms of the etiologic incidence of fungal mass lesions in the central nervous system, whereas cryptococcomas may be the most common, they rarely reach any appreciable size. One form of this specific fungal infection, namely the granulomatous form of cryptococcomatosis, challenges this paradigm, and these lesions can reach an alarming size.
Case Description:
We previously reported a case of multicentric granulomatous cryptococcomas occurring in an adult immunocompetent male patient published in WORLD NEUROSURGERY in mid-2018. We now report that despite confirmed gross total resection and subsequent neurologic improvement having been achieved at that time, the patient was not compliant with his prescribed adjuvant antifungal medical therapy, and for 6 months was lost to follow-up. We now report that the same patient again presented to our unit in early-2019 with recurrent granulomatous cryptococcomas, of an alarming even larger size, in the contralateral hemisphere. Fortunately, were again were able to successfully manage him surgically and have now adapted our surveillance plan to include booked follow-up magnetic resonance imaging.
Conclusions:
According to our review of the English literature, to our knowledge, this is the first report of recurrent granulomatous cryptococcomas occurring in the contralateral hemisphere within 6 months of surgery. The case illustrates the importance of the adjuvant antifungal medial therapy if recurrence is to be avoided.
Insights
Recurrent granulomatous cryptococcomas, a rare fungal infection of the brain, can grow to alarming sizes. Adherence to antifungal therapy is crucial to prevent recurrence after surgical resection.
Area of Science:
- Neurology
- Mycology
- Infectious Diseases
Background:
- Fungal mass lesions in the central nervous system (CNS) are uncommon and rarely cause significant neurologic decline.
- While cryptococcomas are the most frequent fungal CNS lesions, they typically remain small.
- The granulomatous form of cryptococcomycosis can present as unusually large, impactful lesions.
Observation:
- A previously reported case of multicentric granulomatous cryptococcomas in an immunocompetent male patient recurred.
- The patient, initially treated with gross total resection, defaulted on antifungal therapy.
- Recurrence manifested as larger lesions in the contralateral hemisphere within six months.
Findings:
- This case represents the first reported instance of recurrent granulomatous cryptococcomas in the contralateral hemisphere within six months post-surgery.
- Surgical management was successful for the recurrent lesions.
- Magnetic resonance imaging surveillance was adapted for ongoing monitoring.
Implications:
- The case underscores the critical importance of adjuvant antifungal medical therapy to prevent cryptococcoma recurrence.
- Adherence to prescribed antifungal regimens is vital for long-term patient outcomes.
- This highlights a rare but significant challenge in managing granulomatous cryptococcosis.
