Paiva Aline Lariessy Campos, Aguiar Guilherme Brasileiro de, Lovato Renan Maximilian, Zanetti Arthus Vilar Deolindo, Panagopoulos Alexandros Theodoros, Veiga José Carlos Esteves
MD. Resident, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
MSc. Attending Neurosurgeon, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2018 Sep-Oct;136(5):492-496. doi: 10.1590/1516-3180.2017.0046210417. Epub 2017 Nov 6.
Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described.
A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death.
Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.
中枢神经系统（CNS）感染性疾病在发展中国家的患病率很高，其正确的诊断和治疗对公共卫生规划非常重要。新型隐球菌是一种可引起多种中枢神经系统表现的真菌，尤其是在免疫功能低下的患者中。隐球菌性脑膜炎是最常见的受累类型。占位效应病变并不常见：它们被描述为隐球菌瘤，在免疫功能正常的患者中其患病率甚至更低。本文旨在报告一例极其罕见的隐球菌瘤病例，该病例在一名免疫功能正常的患者中引起占位效应并酷似脑肿瘤。我们回顾了关于中枢神经系统隐球菌感染的文献，重点关注隐球菌瘤。描述了一名患有这种罕见的酷似脑肿瘤的隐球菌瘤表现的女性患者的临床、手术和放射学数据。
一名54岁女性患者因快速起病的进行性意识模糊病史以及完全依赖基本活动而就诊于急诊科。神经影像学检查显示左侧枕叶病变，并建议进行神经外科治疗。经组织病理学评估，确诊为隐球菌瘤。她接受了抗真菌药物的临床支持治疗，但尽管进行了最佳的临床治疗，她的病情仍发展至死亡。
隐球菌感染有多种表现形式，在免疫功能正常的患者中，其表现可能更加不同。隐球菌瘤是一种极其罕见的表现形式，应尽快采取适当的手术和临床治疗措施，但即便如此，死亡率仍然很高。
