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Intracranial blastomycoma.

K L Roos, J P Bryan, W W Maggio

    Medicine
    |May 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Central nervous system (CNS) blastomycosis can present as solitary brain masses, not just meningitis. These blastomycomas, often diagnosed via tissue and culture, are treatable with antifungals or surgery.

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    Area of Science:

    • Mycology
    • Neurology
    • Infectious Diseases

    Background:

    • Blastomycosis is a fungal infection primarily affecting the lungs, but it can spread to the central nervous system (CNS).
    • While CNS blastomycosis commonly manifests as meningitis, solitary intracranial mass lesions (blastomycomas) are also recognized presentations.

    Observation:

    • Four patients with solitary intracranial blastomycomas presented with focal neurological deficits.
    • Most patients lacked clear extraneural blastomycosis, and diagnostic tests like complement fixation and immunodiffusion were negative.
    • Computerized tomography (CT) scans showed single mass lesions with enhancement and edema, often misdiagnosed as tumors.

    Findings:

    • Diagnosis was confirmed through intraoperative tissue wet mount, lung lesion culture, or ventricular fluid analysis.

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  • Cerebrospinal fluid cultures from lumbar punctures were consistently negative.
  • All four patients survived, with two treated successfully with Amphotericin B and one with surgical removal.
  • Implications:

    • Solitary intracranial blastomycomas may be more common than previously assumed, especially in endemic areas.
    • CT findings suggestive of a mass lesion in endemic regions should prompt consideration of CNS blastomycoma, even without systemic signs.
    • Definitive diagnosis relies on histopathology and culture, highlighting the importance of these methods in clinical practice.