CNS Cryptococcoma in an Immunocompetent Adult from a Low Resource Setting: An Illustrative Case Report

Abstract

Purpose: Cryptococcal infection in the Central Nervous System (CNS) is frequently seen in human immunodeficiency virus (HIV) patients and others with low immunity. CNS cryptococcoma in immunocompetent patients is rare. We present a case of CNS cryptococcoma in an immunocompetent patient and review literature. Methodology: A 62-year-old, HIV negative, immunocompetent female patient with no known chronic illness, presented with 5 months’ history of a progressive headache, associated with on and off episodic generalized convulsions. She had been to several hospitals before referral to our center with a diagnosis of a brain tumor on CT scan imaging. Before this and despite a negative CSF analysis result, she had received treatment for bacterial meningitis with no success. Findings: At Mbarara Regional Referral Hospital (MRRH), she had surgery with excision biopsy which showed features consistent with cryptococcosis on histology. The patient had a successful adjuvant treatment with antifungal drugs following surgery. Unique Contribution to Theory, Practice and Policy: The diagnosis of a CNS cryptococcal infection in an immunocompetent patient and its successful treatment by including surgery, were both unusual. Fatal postsurgical outcomes have been reported by other authors who favor a totally conservative approach to the treatment of this lesion.