Intracranial fungal mass imitating a high-grade glial lesion - is antifungal alone sufficient?

Intracranial fungal mass is rare among immunocompetent individuals with variable presentation and management algorithms making it challenging to achieve optimal outcomes.

Herein, we report the presentation of a 34-year-old immunocompetent Pashtun female with acute-onset rapidly progressing generalized weakness, altered cognition, and motor and speech deficits. Although the radiological findings resembled a glioblastoma, the strong clinical suspicion of a fungal infection and her improvement on voriconazole treatment led to the decision to avoid surgical resection, thereby minimizing the risk of potential dissemination.

Our case emphasizes that any deviation from the typical presentation of high-grade tumors must be reviewed with the need for surgical resection being evaluated on a case-to-case basis while prioritizing patient outcomes.