CNS cryptococcoma in an HIV-positive patient.
This is the first case of brain cryptococcoma in an AIDS patient reported in Argentina. The patient was a 28-year-old white heterosexual man with AIDS who presented with altered mental status, seizures, visual hallucinations, headache, and fever without significant focal neurological deficit. He had a lumbar puncture, and was treated for cryptococcal meningitis. Subsequent brain CT scanning and MRI disclosed a mass lesion in the occipital lobe. Histopathological examination of biopsy was compatible with cryptococcoma, and tissue culture revealed Cryptococcus neoformans. Resolution of the mass and edema resulted after treatment with intravenous amphotericin B for six weeks, which was followed with maintenance oral fluconazole. Intracranial mass is an uncommon complication in AIDS patients with cryptococcosis, and cryptococcoma should be considered as differential diagnosis of brain mass lesion in these patients. The etiologic diagnosis is necessary because central nervous system (CNS) toxoplasmosis, lymphoma, and tuberculoma can produce similar clinical syndromes and MRI or CT findings to cryptococcoma. Also, these pathologies may coexist with meningeal cryptococcosis.
Troncoso
Alcides
A
University of Buenos Aires, Francisco J Muñiz Hospital, Buenos Aires, Argentina. alcidestr@hotmail.com
Fumagalli
Julio
J
Shinzato
Ruben
R
Gulotta
Héctor
H
Toller
Marcela
M
Bava
Javier
J
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole