CNS cryptococcosis

Case contributed by Dr James Harvey

Presentation

New confusion and first seizure. Febrile >40°C. History of alcohol excess.

Patient Data

Age: 40-50 years
Gender: Male
CT

There are multiple (at least 7) enhancing lesions within the basal ganglia bilaterally. The largest lesion within the left internal capsule measures 16 mm in maximal dimension.

MRI

MRI brain

There are multiple T1 hypointense and T2 hyperintense lesions which suppress on FLAIR with a thin FLAIR hyperintense rim. There is minimal contrast enhancement and surrounding vasogenic edema. This constellation of findings is consistent with cryptococcus gelatinous pseudocysts.

A number of lesions (>10) display contrast enhancement and are associated with surrounding vasogenic edema. These lesions are in keeping with cryptococcomas.

The lesion within the right occipital lobe exhibits mild restricted diffusion. 
No leptomeningeal enhancement or nodularity to indicate meningitis.

Case Discussion

Cryptoccosis is a fungal infection which is commonly an opportunistic infection in immunosuppressed patients. 
It has a propensity to involve the basal ganglia and frequently leads to hydrocephalus.

In this case, the patient returned positive sputum samples for cryptococcus. He was treated with prolonged IV fluconazole and improved without requiring surgery.

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Case information

rID: 70895
Published: 8th Sep 2019
Last edited: 9th Sep 2019
Inclusion in quiz mode: Included

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