Intracranial Cryptococcoma Mimicking Stroke or Brain Tumor: A Diagnostic Challenge in an Immunocompetent Patient

TL;DR

A rare case of brain cryptococcal infection in a healthy person was misdiagnosed as a stroke or tumor, emphasizing the need for careful evaluation and early treatment.

Contribution

Highlights diagnostic challenges of cryptococcal infections in immunocompetent patients mimicking stroke or brain tumors.

Findings

Cryptococcomas can present with atypical MRI findings resembling stroke or tumors in immunocompetent individuals.

Detailed history and imaging interpretation are crucial for timely diagnosis of cryptococcal infections.

Early antifungal therapy is essential for successful treatment in such cases.

Abstract

Central nervous system (CNS) cryptococcal infections can manifest as meningitis in immunocompromised patients. Although CNS cryptococcal infections are rare in immunocompetent individuals, when they do occur, they often present as cryptococcomas rather than meningitis. We report a case of an immunocompetent patient who was initially suspected of cerebral infarction but was finally diagnosed with a central cryptococcal infection, highlighting the challenges of diagnosing it in these patients and the importance of early intervention.

A 58-year-old immunocompetent man with a prior transient ischemic attack and stroke presented with transient dysarthria and right upper extremity paralysis, initially raising suspicion of cerebral infarction. However, atypical findings on diffusion-weighted imaging (DWI) and pronounced cerebral edema prompted further evaluation. Contrast-enhanced magnetic resonance imaging (MRI) showed a ring-enhancing lesion, raising suspicion of a brain tumor. Biopsy confirmed an unexpected diagnosis of cryptococcosis. Further history-taking revealed that the patient worked in a factory handling agricultural equipment, which was frequently visited by pigeons, a known risk factor for cryptococcal exposure. The patient was treated with antifungal therapy and discharged.

Immunocompetent patients with central cryptococcal infections that mimic other conditions, such as stroke or brain tumors, may present diagnostic challenges. Detailed history taking, symptom evaluation, and accurate imaging interpretation are crucial for timely diagnosis and intervention. Early antifungal therapy is crucial and highlights the importance of considering cryptococcal infections even if atypical symptoms or misleading MRI findings are present.

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