Successful Medical Treatment of Multiple Cryptococcomas : Report of a Case and Literature Review
ARKHOM ARAYAWICHANONT, M.D.*,
NARAPORN PRAYOONWIWAT, M.D.*,
ANCHALEE CHUROJANA, M.D.**,
TUMTIP SANGRUCHI, M.D.***,
NIPHON POUNGVARIN, F.R.C.P., F.R.C.P.(Edin), F.R.C.P.(Giasg).*
Affiliation : * Division of Neurology, Department of Medicine,
** Department of Radiology,
*** Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractWe report a 35 year old man diagnosed as having CNS cryptococcosis with multiple cryp-
tococcomas, presenting with headache, papilloedema and impaired mental function in a previously
healthy man. Cerebrospinal fluid (CSF) examination revealed lymphocytic pleocytosis with low
glucose level. Gram's stain, acid fast bacilli stain and Indian ink examination were all negative.
CSF cryptococcal antigen was positive, however, several fungal cultures were negative. Early
cranial CT scan showed focal cerebritis over the right temporal lobe while subsequent imaging
studies showed multiple contrast-enhancing masses with severe surrounding brain oedema over
bilateral frontoparietal areas. Brain biopsy showed cryptococcal granulomatous lesions. Treatment
was successful with antifungal agents and steroids without surgical removal.
Keywords : Cerebral Cryptococcosis, Cryptococcoma, CNS Cryptococcosis
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