rss
BMJ Case Reports 2017; doi:10.1136/bcr-2016-218824
  • CASE REPORT

Cerebral cryptococcoma mimicking glioblastoma

  1. Marion L Woods1,2
  1. 1Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  2. 2University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Dr Marion L Woods, marion.woods{at}health.qld.gov.au
  • Accepted 26 January 2017
  • Published 10 February 2017

Summary

Cryptococcus neoformans and C. gattii cause invasive fungal disease, with meningitis being the most common manifestation of central nervous system (CNS) disease. Encapsulated cryptococcomas occur rarely, predominantly in immunocompetent hosts, usually related to C. gattii. Our patient was an immunocompetent man who presented with headache and a large cystic CNS lesion thought to be glioblastoma. Biopsy of a concomitant lung lesion confirmed cryptococcoma and empiric antifungal therapy was started for presumed CNS cryptococcoma. Antifungal therapy failed to shrink the CNS lesion, and surgical excision confirmed C. gattii CNS cryptococcoma. Following surgery he had complete resolution of symptoms. This case highlights that cryptococcoma cannot be distinguished from tumour on clinical or imaging findings. A combined medical and surgical approach is optimal for the management of large or surgically accessible cryptococcomas, as antifungal therapy alone is unlikely to penetrate large lesions sufficiently to lead to a cure.

Footnotes

  • Contributors KBU wrote the first draft and completed an extensive literature review as well as participating in the acute and ongoing medical care of the patient. JWJC assisted in the literature review and care of the patient when in neurosurgery. RJ was the consultant neurosurgeon who performed the surgery and filmed the attached procedure. MLW edited the final draft and was involved in the ongoing medical management and follow-up of the patient.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article