Multiple Central Nervous System Cryptococcomas Masquerading as Lymphoma

Area of Science:

• Infectious Diseases
• Neurology
• Immunology

Background:

• Cryptococcal meningitis is a significant cause of death in HIV patients, typically occurring with low CD4 counts (<100 cells/mm³).
• Cryptococcomas, rare granulomatous lesions, are usually found in the central nervous system of immunocompetent individuals with disseminated cryptococcal infection.

Observation:

• A case of disseminated cryptococcal meningitis with multiple cryptococcomas was observed in an HIV-positive patient with a CD4 count of 115 cells/mm³.
• These lesions mimicked metastatic disease on initial assessment.
• Standard diagnostic tests, including serum and cerebrospinal fluid (CSF) cryptococcal antigen, PCR, and cultures, were negative.

Findings:

• Diagnosis was confirmed through brain biopsy pathology.
• This case demonstrates cryptococcomas can occur in HIV patients with CD4 counts above the typical threshold.

Implications:

• Highlights the diagnostic challenge of cryptococcomas in HIV patients, especially when serological and molecular tests are negative.
• Emphasizes the critical role of early cerebral biopsy for accurate diagnosis and timely management of cryptococcoma.
• Suggests a need to consider cryptococcoma in the differential diagnosis of CNS lesions in HIV patients, irrespective of CD4 count thresholds.