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CNS Histoplasmosis as a Gliosarcoma mimicker: The diagnostic dilemma of solitary brain lesions
Suha Abu Khalaf1, Paragkumar Patel1, Carla R Caruso2
1University of Missouri, Division of Infectious Diseases, Columbia, MO, USA.
Abstract:
Histoplasmosis is usually a benign, self-limited disease with lungs predilection. However, it might manifest as a disseminated disease in immunocompromised individuals. The involvement of the central nervous system (CNS) accounts for about 5-10% of cases with disseminated disease. Isolated histoplasmosis of the CNS is rare, and the literature shows only a few reported cases. By imaging studies, it usually presents as an isolated ring-enhancing lesion. Its spectrum of symptoms ranges from acute severe infection to progressive chronic meningitis, which delays the initial diagnosis, correct work-up and initiation of appropriate therapy. We present a case of a 57-year-old man from the Midwest of the United States who misdiagnosed with Gliosarcoma in 2019, for which he underwent appropriate management for Gliosarcoma. Presented for follow-up after new neurological symptoms; worsening in ring-enhancing brain lesions was found on magnetic resonance image MRI. After a re-examination of surgical pathological cases, histoplasmosis of the CNS was diagnosed. Failure of diagnosis CNS histoplasmosis early can lead to poor outcome and decrease chances of recovery.
Insights
Central nervous system (CNS) histoplasmosis, though rare, can mimic other serious conditions like brain tumors. Early diagnosis is crucial for effective treatment and improved patient outcomes in this fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Histoplasmosis typically affects the lungs but can disseminate in immunocompromised individuals.
- Central nervous system (CNS) involvement occurs in 5-10% of disseminated histoplasmosis cases.
- Isolated CNS histoplasmosis is exceptionally rare, often presenting as a ring-enhancing lesion on imaging.
Observation:
- A 57-year-old male initially misdiagnosed with Gliosarcoma received treatment for this condition.
- New neurological symptoms and worsening ring-enhancing brain lesions on MRI prompted re-evaluation.
- Re-examination of surgical pathology confirmed CNS histoplasmosis, not Gliosarcoma.
Findings:
- The case highlights the diagnostic challenge of CNS histoplasmosis mimicking primary brain tumors.
- Delayed diagnosis of CNS histoplasmosis can lead to poor prognosis and reduced recovery chances.
- Accurate and timely diagnosis is essential for appropriate antifungal therapy.
Implications:
- This case underscores the importance of considering fungal infections in the differential diagnosis of ring-enhancing brain lesions, especially in endemic areas.
- Raising awareness among clinicians about rare presentations of CNS histoplasmosis can improve patient management.
- Further research into early diagnostic markers for CNS histoplasmosis is warranted.
