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Intraventricular cryptococcoma mimicking a neoplastic lesion in an immunocompetent patient with hydrocephalus: A case
Xavier A Santander1, Raquel Gutiérrez-González1, Carlos Cotúa1
1Departments of Neurosurgery.
Insights
Cryptococcosis, a fungal infection, can present as an intraventricular mass in immunocompetent individuals. Early diagnosis and treatment are crucial for cryptococcoma management, though complications can be severe.
Area of Science:
- Neuroscience
- Infectious Diseases
- Mycology
Background:
- Cryptococcosis is a significant fungal infection affecting the central nervous system.
- Intraventricular cryptococcoma is a rare but critical differential diagnosis for intraventricular masses, even in immunocompetent hosts.
Observation:
- A case of an immunocompetent 41-year-old female presented with an intraventricular cryptococcoma caused by Cryptococcus neoformans.
- The lesion mimicked a primary brain tumor, leading to initial misdiagnosis and surgical intervention.
- Hydrocephalus was a complicating factor, necessitating further management.
Findings:
- The infectious etiology of the intraventricular mass was identified post-operatively.
- Systemic antifungal therapy was initiated, alongside the placement of a ventriculoperitoneal shunt for hydrocephalus management.
- Despite interventions, the patient experienced a fatal outcome due to complications.
Implications:
- This case underscores the importance of considering fungal infections like cryptococcosis in the differential diagnosis of intraventricular masses in immunocompetent individuals.
- Raising clinical suspicion for cryptococcoma can lead to earlier diagnosis and appropriate management.
- Understanding the potential complications and treatment strategies for intraventricular cryptococcoma is vital for patient outcomes.
Background:
The aim of this study is to highlight the importance of cryptococcosis as one of the most common fungal infections of the central nervous system, stressing the consideration of a cryptococcoma within the list of differential diagnosis of intraventricular masses in immunocompetent hosts.
Case Description:
We present the case of an immunocompetent 41-year-old female from Philippines with an intraventricular cryptococcoma due to Cryptococcus neoformans, mimicking an intraventricular primary brain tumor, who had hydrocephalus. She was approached as having a neoplastic lesion and underwent surgical resection plus third ventriculostomy through endoscopy. Later in her evolution, we realized the infectious nature of the lesion, and antifungal systemic therapy was initiated. In the end, she needed the placement of a ventriculoperitoneal shunt to maintain a good neurologic status. Despite all our efforts, she had a fatal outcome due to various complications.
Conclusion:
Our case is the first intraventricular cryptococcoma due to C. neoformans, as far as we know, to be reported in English, German, or Spanish literature. Our report stresses the importance to consider this kind of infection in immunocompetent patients, to raise the level of suspicion of this diagnosis, and to know the complications and management options.
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