Ortiz Alexander V, Mehta Dhruven, Horton Juli, Jarquin-Valdivia Adrian A
Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
Department of Internal Medicine, TriStar Centennial Medical Center, Nashville, TN, USA.
Neurohospitalist. 2024 Dec 9:19418744241307413. doi: 10.1177/19418744241307413.
Cryptococcal meningitis is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus. In over 90% of cases, it occurs at CD4 T lymphocyte (CD4) cell counts of less than 100 cells/mm. Cryptococcomas are rare granulomatous lesions that can occur in disseminated central nervous system cryptococcal infection, primarily in immunocompetent hosts. Here we report a case of disseminated cryptococcal meningitis with numerous cryptococcomas mimicking metastases in a patient with HIV and a CD4 count of 115. The patient's serum and cerebrospinal fluid (CSF) cryptococcal antigen, CSF cryptococcal polymerase chain reaction, and serum and CSF cryptococcal cultures were all negative. Brain biopsy pathology confirmed the diagnosis. In this paper, we highlight the importance of early cerebral biopsy in the diagnosis and management of cryptococcoma.
隐球菌性脑膜炎是人类免疫缺陷病毒感染患者发病和死亡的主要原因。在超过90%的病例中，它发生在CD4 T淋巴细胞（CD4）计数低于100个细胞/mm³时。隐球菌瘤是罕见的肉芽肿性病变，可发生在播散性中枢神经系统隐球菌感染中，主要见于免疫功能正常的宿主。在此，我们报告一例CD4计数为115的HIV患者发生播散性隐球菌性脑膜炎并伴有大量类似转移瘤的隐球菌瘤的病例。患者的血清和脑脊液（CSF）隐球菌抗原、CSF隐球菌聚合酶链反应以及血清和CSF隐球菌培养均为阴性。脑活检病理确诊了诊断。在本文中，我们强调了早期脑活检在隐球菌瘤诊断和治疗中的重要性。
