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Published on: January 17, 2018
Pituitary cryptococcoma in an immunocompetent patient with panhypopituitarism: illustrative case
Emmanuel Maciel-Ramos1, Luis A Castillejo-Adalid1, Job J Rodríguez-Hernández1
1Departments of1Neurosurgery, and.
Insights
This case report details an exceptional instance of pituitary cryptococcoma, a rare fungal infection of the brain, in an immunocompetent patient. It highlights the successful surgical and medical treatment of this unusual central nervous system mycosis.
Area of Science:
- Neurology
- Infectious Diseases
- Endocrinology
Background:
- Cryptococcosis is a significant cause of central nervous system mycosis, primarily affecting immunocompromised individuals.
- While meningitis is the common presentation, intra-axial lesions like cryptococcoma are less frequent and more typical in immunocompetent hosts.
- Pituitary cryptococcoma is an exceptionally rare manifestation, with limited documented cases in medical literature.
Purpose of the Study:
- To report and discuss an unusual case of pituitary cryptococcoma in an immunocompetent patient.
- To review the clinical, imaging, and therapeutic aspects of this rare entity.
- To emphasize the importance of considering cryptococcoma in the differential diagnosis of pituitary masses.
Main Methods:
- Presentation of a case study involving a 30-year-old immunocompetent male with a pituitary mass and panhypopituitarism.
- Surgical resection of the pituitary mass via endonasal endoscopic transsphenoidal approach.
- Histopathological confirmation of pituitary cryptococcoma and subsequent medical management with antifungal agents.
Main Results:
- Histopathological diagnosis confirmed pituitary cryptococcoma.
- The patient underwent successful surgical resection and medical treatment.
- This case represents one of the few documented instances of pituitary cryptococcoma in an immunocompetent individual.
Conclusions:
- Pituitary cryptococcoma, though rare, should be considered in the differential diagnosis of sellar region masses, even in immunocompetent patients.
- Multidisciplinary management involving neurosurgery, infectious disease specialists, and endocrinology is crucial for optimal outcomes.
- This case contributes valuable insights into the diagnosis and management of this exceptional clinical presentation.
Background:
Cryptococcosis is the most common mycosis of the central nervous system. It may develop in immunocompetent and immunocompromised patients, the latter representing most cases. The most common presentation of the disease is meningitis, whereas intra-axial lesions in the form of cryptococcoma are less frequent with a greater tendency to present in immunocompetent patients. The presentation of pituitary cryptococcoma is exceptional. To the best of the authors' knowledge, there is only one case published in the medical literature.
Observations:
The authors present the case of a 30-year-old male without a relevant medical history. He was referred to our center with a pituitary mass on magnetic resonance imaging and panhypopituitarism. The patient underwent endonasal endoscopic transsphenoidal tumor resection, and a histopathological diagnosis of pituitary cryptococcoma was made. Medical management included fluconazole and intravenous amphotericin.
Lessons:
This case underscores the neurosurgical and medical management of an exceptional clinical presentation of pituitary cryptococcoma in an immunocompetent patient. To the best of the authors' knowledge, there is only one case published in the medical literature. This case provides an invaluable review of the clinical, imaging, and therapeutic considerations regarding this exceptional clinical entity.
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