[Intracranial fungal granuloma with CSF space dissemination: a case report]

A 28-year-old male presented with a low grade fever, decreased activity, left hemiparesis and signs of intracranial hypertension. CT showed a moderate hydrocephalus and a large irregular mass in the right temporoparietal region with garland-like enhancement after injection of the contract medium. These findings suggested a malignant brain tumor. MR images demonstrated a mass with low-iso signal intensity on T1 weighted image and low-iso-high mixed intensity on T2, which is like a mosaic pattern. Multiple cerebrospinal fluid space seedings including the wall of the lateral ventricle, the surface of the cerebellum and pons, and the cervical spinal cord were clearly delineated on MR images after Gd-DTPA injection. The large mass was totally removed by craniotomy after ventricle drainage for hydrocephalus. Microscopic examinations showed dense fibrous connective tissue with infiltration of Langhans' giant cells, lymphocytes and fibroblasts around the necrotic centers. These hard components may have been responsible for the low signal intensity on T2-MR images. Many Candida elements were clearly shown with the periodic acid Schiff stain. The diagnosis was that the lesion was an intraparenchymal granuloma due to Candida infection. The patient died on the 8th postoperative day because of brain stem malfunction. Intracranial fungal infection rarely produces a granuloma in the central nervous system. Though it is difficult to diagnose a large irregular mass in the brain, MR images, especially T2 weighted images are useful for the diagnosis of fungal granuloma.