1887

JMM Case Reports

Volume 2, Issue 3

Cerebellar cryptococcoma due to VGI; a rare and first report from India Open Access

Abstract

Introduction:

is an emerging global pathogen. Recent reports suggest that cryptococcosis is more common in immunocompetent as well as HIV-infected patients than earlier estimated. We report the first case of cerebellar cryptococcoma from India due to in an immunocompetent individual.

Case Presentation:

A 73-year-old immunocompetent male, presented with a 3 month history of severe headache, neck stiffness, walking difficulty, bilateral papilloedema and slight cerebellar signs including gait imbalance and giddiness. Magnetic resonance imaging (MRI) revealed a well-defined enhancing lesion in the cerebellum, suggestive of abscess and mild hydrocephalus. Blood parameters and liver function tests were within normal limits. The patient underwent paramedian suboccipital craniotomy, and the aspirated purulent material grew . Histologically, the lesion was a cryptococcoma. The isolate was further identified as VGI, serotype C, mating type alpha, and produced extracellular phospholipase enzyme. It was sensitive to amphotericin B, 5-flucytosine and azoles. The patient was treated with intravenous amphotericin B (0.7 mg kg day) for 15 days along with a maintenance dose of oral fluconazole (400 mg day) for 6 months. The patient's symptoms recovered while on treatment but he was lost to follow up.

Conclusion:

is an emerging pathogen in India that affects otherwise healthy, immunocompetent individuals and requires rapid identification and treatment in order to prevent severe neurological sequelae.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): antifungal susceptibility , cerebellar cryptococcoma , Cryptococcus gattii and immunocompetent
© 2015 The Authors
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.000052
2015-06-01
2023-09-25
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/2/3/jmmcr000052.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.000052&mimeType=html&fmt=ahah

References

  1. Billah N.M, Amil T, Chaouir S. 2014; Intracranial cryptococcal infection in HIV positive patient. Open J Clin Diagn 4:1–4 [CrossRef]
     [Google Scholar]
  2. Byrnes E.J III, Li W, Lewit Y, Perfect J.R, Carter D.A, Cox G.M, Heitman J. 2009; First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen. PLoS One 4:e5851 [CrossRef]
     [Google Scholar]
  3. Casali A.K, Goulart L, Rosa e Silva L.K, Ribeiro A.M, Amaral A.A, Alves S.H, Schrank A, Meyer W, Vainstein M.H. 2003; Molecular typing of clinical and environmental Cryptococcus neoformans isolates in the Brazilian state Rio Grande do Sul. FEMS Yeast Res 3:405–415 [CrossRef]
     [Google Scholar]
  4. Chowdhary A, Rhandhawa H.S, Prakash A, Meis J.F. 2012; Environmental prevalence of Cryptococcus neoformansCryptococcus gattii in India: an update. Crit Rev Microbiol 38:1–16 [CrossRef]
     [Google Scholar]
  5. Cogliati M. 2013; Global molecular epidemiology of Cryptococcus neoformansCryptococcus gattii: an atlas of the molecular types. Scientifica 2013:675213 [CrossRef]
     [Google Scholar]
  6. Cogliati M, Chandrashekar N, Esposto M.C, Chandramuki A, Petrini B, Viviani M.A. 2012; Cryptococcus gattii serotype-C strains isolated in Bangalore, Karnataka, India. Mycoses 55:262–268 [CrossRef]
     [Google Scholar]
  7. Colom M.F, Frasés S, Ferrer C, Jover A, Andreu M, Reus S, Sánchez M, Torres-Rodríguez J.M. 2005; First case of human cryptococcosis due to Cryptococcus neoformans var. gattii in Spain.. J Clin Microbiol 43:3548–3550 [CrossRef]
     [Google Scholar]
  8. Colombo F.A, Elsemann R.B, Conde A, Galafassi D, Gazzoni A.F. 2014; Updating: cryptococcosis diagnostic aspects. J AIDS Clin Res 5:1–7
     [Google Scholar]
  9. Gültaşli N.Z, Ercan K, Orhun S, Albayrak S. 2007; MRI findings of intramedullary spinal cryptococcoma. Diagn Interv Radiol 13:64–67
     [Google Scholar]
  10. Gurung S, Sherpa N.T, Yoden Bhutia P, Pradhan J, Peralam Yegneshwaran P. 2012; Cryptococcus gatti serotype B isolated in Sikkim (north-east India)–A new geographical niche. Med Mycol Case Rep 1:27–28 [CrossRef]
     [Google Scholar]
  11. Harris J.R, Lockhart S.R, Sondermeyer G, Vugia D.J, Crist M.B, D'Angelo M.T, Sellers B, Franco-Paredes C, Makvandi M, other authors. 2013; Cryptococcus gattii infections in multiple states outside the US Pacific Northwest. Emerg Infect Dis 19:1620–1626
     [Google Scholar]
  12. Hernández Y.U, Monzón J.F, Delgado-Hernández R, Soto-Hernández J.L, Cárdenas G. 2013; Cryptococcoma of the brain in an immunocompetent man. Natl Med J India 26:216–217
     [Google Scholar]
  13. Ito-Kuwa S, Nakamura K, Aoki S, Vidotto V. 2007; Serotype identification of Cryptococcus neoformans by multiplex PCR. Mycoses 50:277–281 [CrossRef]
     [Google Scholar]
  14. Jung A, Korsukewitz C, Kuhlmann T, Richters M, Fischer B, Niederstadt T, Fegeler W, Minnerup J, Young P, Husstedt I.W. 2012; Intracerebral mass lesion diagnosed as cryptococcoma in a patient with sarcoidosis, a rare opportunistic manifestation induced by immunosuppression with corticosteroids. J Neurol 259:2147–2150 [CrossRef]
     [Google Scholar]
  15. Li Q, You C, Liu Q, Liu Y. 2010; Central nervous system cryptococcoma in immunocompetent patients: a short review illustrated by a new case. Acta Neurochir (Wien) 152:129–136 [CrossRef]
     [Google Scholar]
  16. Moráňová Z. 2013; Response of pathogenic yeast Cryptococcus neoformans to hypoxia. PhD thesis. Palacký University, Olomouc
     [Google Scholar]
  17. Nakwan N, Songjamrat A, Tungsinmonkong K, Nakwan N. 2009; Cerebellar cryptococcoma in an immunocompetent adult patient. Southeast Asian J Trop Med Public Health 40:1034–1037
     [Google Scholar]
  18. Okamoto K, Hatakeyama S, Itoyama S, Nukui Y, Yoshino Y, Kitazawa T, Yotsuyanagi H, Ikeda R, Sugita T, Koike K. 2010; Cryptococcus gattii genotype VGIIa infection in man, Japan, 2007. Emerg Infect Dis 16:1155–1157 [CrossRef]
     [Google Scholar]
  19. Rai S, Marak R.S, Jain S, Dhole T.N. 2012; Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia. Indian J Med Microbiol 30:367–370 [CrossRef]
     [Google Scholar]
  20. Sillero-Filho V.J, Souza A.B, Vaitsman R.P, Morais R.A, Coutinho P.O, Lengruber R, Salame J.M, Guedes-Corrêa J.F, Louzada P.R. 2009; Cerebellar cryptococcoma simulating metastatic neoplasm. Arq Neuropsiquiatr 67:2A290–292 [CrossRef]
     [Google Scholar]
  21. Trilles L, Fernández-Torres B, dos Santos Lazéra M, Wanke B, Guarro J. 2004; In vitro antifungal susceptibility of Cryptococcus gattii.. J Clin Microbiol 42:4815–4817 [CrossRef]
     [Google Scholar]
  22. Velamakanni S.S, Bahr N.C, Musubire A.K, Boulware D.R, Rhein J, Nabeta H.W. 2014; Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus. Med Mycol Case Rep 6:10–13 [CrossRef]
     [Google Scholar]
  23. Wright L, Bubb W, Davidson J, Santangelo R, Krockenberger M, Himmelreich U, Sorrell T. 2002; Metabolites released by Cryptococcus neoformans var. neoformans and var. gattii differentially affect human neutrophil function. Microbes Infect 4:1427–1438 [CrossRef]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.000052
Loading
Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India
JMM Case Rep 2, e000052 (2015); https://doi.org/10.1099/jmmcr.0.000052
/content/journal/jmmcr/10.1099/jmmcr.0.000052
/content/journal/jmmcr/10.1099/jmmcr.0.000052
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error