Cryptococcomas are a rare complication of infection by the Cryptococcus genus of invasive fungi, where a discreet, encapsulated lesion of immune infiltrates and pathogen forms. Cryptococcus gattii is most often isolated but Cryptococcus neoformans may also form cryptococcomas.
In general, cryptococcosis occurs secondary to AIDS-related immunodeficiency and so the incidence is higher in countries afflicted by HIV infection, namely Sub-Saharan Africa. Cryptococcus has been isolated, globally 1. Interestingly, cryptococcoma are more commonly found in the immunocompetent, as Cryptococcus gattii infections are more frequent in healthy hosts 2. Case reports of cryptococcoma have been published from a variety of countries, including India, Australia, New Zealand and Uganda 2-5.
Sporadic infection in the immunocompetent is most often reported 2,4. The presentation of cryptococcoma depends on which organ is affected - of note, multi-organ involvement may be observed. In the CNS, hydrocephalus and symptoms of raised intracranial pressure are common; pulmonary infection may present with pleuritic chest pain and fever 5; a case of intra-abdominal cryptococcoma presented as chronic abdominal pain, intestinal thickening, lymphadenopathy and perforation 6. Diagnosis is made following biopsy, is considered on the basis of multiple lesions consistent with cryptococcosis or assumed in the context of historical cryptococcosis. Interestingly, cryptococcoma formation has been reported to occur following AIDS-associated CNS cryptococcosis and up to 70 days following treatment with both anti-fungal and antiretroviral therapy 3.
The two Cryptococcus species implicated in cryptococcoma are Cryptococcus gattii and Cryptococcus neoformans 7,8. Both species find their natural habitat in the decaying tree bark of a number of tree species and have been isolated from soil, air and avian excreta 9. It is thought that human infection occurs following inhalation, penetration of the lung parenchyma and hematological dissemination 4. Multiple organs are therefore vulnerable to infection.
- T1: hypointense 10,4
- T2: hyperintense, with or without vasogenic edema, depending on size 10,4
- T1C+: contrast-enhancing rim may be seen
Treatment and prognosis
Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 recommends fluconazole treatment for 12–18 months, with a minimum course duration of 6 months 4. Corticosteroids may be required for the control of surrounding edema, particularly in CNS disease 4. Prognosis is poor as lesions may be resistant to treatment, particularly in the immunocompromised 4.
CNS lesions can be mistaken for neoplasms, especially in the context of an immunocompetent host 4,11.
- 1. Sloan DJ, Parris V. Cryptococcal meningitis: epidemiology and therapeutic options. (2014) Clinical epidemiology. 6: 169-82. doi:10.2147/CLEP.S38850 - Pubmed
- 2. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. (2010) Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 50 (3): 291-322. doi:10.1086/649858 - Pubmed
- 3. Velamakanni SS, Bahr NC, Musubire AK, Boulware DR, Rhein J, Nabeta HW. Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus. (2014) Medical mycology case reports. 6: 10-3. doi:10.1016/j.mmcr.2014.08.003 - Pubmed
- 4. Ulett KB, Cockburn JW, Jeffree R, Woods ML. Cerebral cryptococcoma mimicking glioblastoma. (2017) BMJ case reports. doi:10.1136/bcr-2016-218824 - Pubmed
- 5. Haddad N, Cavallaro MC, Lopes MP, Fernandez JM, Laborda LS, Otoch JP, Ferreira CR. Pulmonary cryptococcoma: a rare and challenging diagnosis in immunocompetent patients. (2015) Autopsy & case reports. 5 (2): 35-40. doi:10.4322/acr.2015.004 - Pubmed
- 6. Musubire AK, Meya DB, Lukande R, Kambugu A, Bohjanen PR, Boulware DR. Gastrointestinal cryptococcoma - Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?. (2015) Medical mycology case reports. 8: 40-3. doi:10.1016/j.mmcr.2015.03.004 - Pubmed
- 7. Chen SC, Meyer W, Sorrell TC. Cryptococcus gattii infections. (2014) Clinical microbiology reviews. 27 (4): 980-1024. doi:10.1128/CMR.00126-13 - Pubmed
- 8. Gaona-Flores VA. Central nervous system and Cryptococcus neoformans. (2013) North American journal of medical sciences. 5 (8): 492-3. doi:10.4103/1947-2714.117321 - Pubmed
- 9. Chowdhary A, Rhandhawa HS, Prakash A, Meis JF. Environmental prevalence of Cryptococcus neoformans and Cryptococcus gattii in India: an update. (2012) Critical reviews in microbiology. 38 (1): 1-16. doi:10.3109/1040841X.2011.606426 - Pubmed
- 10. Shayanki Lahiri Mukhopadhyay, Mukesh Kumar, Yasha T. Chickabasaviah, Veena Kumari H. Bahubali, Prabhu A.R. Raj, Rose Dawn Bharath, Nagarathna Siddaiah. Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India. (2015) JMM Case Reports. 2 (3): e000052. doi:10.1099/jmmcr.0.000052
- 11. Carol L, Tai MS, Yusoff SM, Rose N, Rafia MH, Viswanathan S. Spinal cryptoccoma mimicking a spinal cord tumor complicated by cryptococcal meningitis in an immunocompetent patient. (2018) Neurology India. 66 (4): 1181-1183. doi:10.4103/0028-3886.237012 - Pubmed