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Central nervous system Cryptococcoma mimicking demyelinating disease: a case report.

Jie Wei1, Xiang-Yu Li2, Yue Zhang3

  • 1Department of neurology, 905th hospital of PLA Navy, No 1328 Huashan Road, Changning District, Shanghai, 200052, China.

BMC Neurology
|August 14, 2020
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Summary

Cerebral cryptococcomas, a rare fungal infection, can mimic demyelinating diseases on MRI scans. Early diagnosis is crucial for effective treatment of this challenging central nervous system condition.

Keywords:
Central nervous system cryptococcosisCorticosteroidCryptococcomasTumefactive demyelinating lesion

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Cerebral cryptococcomas are rare central nervous system fungal infections.
  • They are often misdiagnosed as neoplasms prior to surgical intervention.
  • This case highlights the potential for misdiagnosis as demyelinating disease.

Observation:

  • A 40-year-old male presented with progressive unconsciousness.
  • Brain MRI showed a corpus callosum mass with rim enhancement, initially suspected as demyelinating disease.
  • Corticosteroid treatment provided temporary improvement, followed by neurological deterioration and new MRI lesions.

Findings:

  • Cerebrospinal fluid analysis confirmed Cryptococcus neoformans infection.
  • Positive Cryptococcus antigen tests were noted in serial cerebrospinal fluid samples.
  • Despite antifungal therapy, the patient's condition worsened, leading to mortality.

Implications:

  • Cerebral cryptococcomas present significant diagnostic challenges.
  • Radiological similarity to demyelinating lesions complicates early and accurate diagnosis.
  • This case underscores the importance of considering fungal infections in unexplained neurological presentations.