Presentation
Two months of headache. No focal neurology. Smoker. No past medical history.
Patient Data
Vasogenic edema in the occipital lobes (R>L) and the right cerebellar hemisphere.
No hydrocephalus.
Further evaluation with contrast enhanced CT brain required.
Multiple intra-axial enhancing lesions in the right cerebellar hemisphere, bilateral occipital lobes at the grey-white matter junction and the right basal ganglia. Surrounding vasogenic edema.
Enhancing lesions in the occipital lobes, right globus pallidus and right cerebellar hemisphere, with predominantly peripheral enhancement in the right occipital and cerebellar lesions.
The lesions are T2 high, T1 low signal with facilitated diffusion (high ADC values).
Surrounding vasogenic edema/high T2 signal.
CT CAP performed for malignancy staging chest images shown
Homogeneous low density mass in the basal right lower lobe which has an elliptical shape (seen best on coronal and sagittal planes). This shape and density is somewhat atypical of a primary malignancy (this observation was made in retrospect).
Post obstructive subsegmental atelectasis (note the density difference between the lesion and the collapsed lung).
The left lung is clear.
No lymphadenopathy.
Case Discussion
Histopathology from the cerebellar lesion resection and bronchoscopy demonstrated Cryptococcus gatti.
Australia and Papua New Guinea are sites of C. gatti endemic disease and it has been associated with exposure to certain species of eucalyptus trees.
Cryptococcus gatti infection is typically seen in immunocompetent individuals and is significantly more likely to cause large mass lesions (cryptococcomas) in the lungs and brain, compared to C. neoformans.