Cerebellar cryptococcoma in an immunocompetent child. Case report

J Neurosurg. 2007 Oct;107(4 Suppl):314-7. doi: 10.3171/PED-07/10/314.

Abstract

This is the first report of a cerebellar cryptococcoma in a previously healthy, HIV-negative child. Cryptococcus neoformans is an opportunistic fungus that typically affects patients who are HIV-positive and other patients with compromised immune systems. Isolated cryptococcomas of the central nervous system (CNS) have been previously described in immunocompetent adults; however, this is the first report of a cryptococcoma in a child. The patient presented with progressive headaches and nausea and was found to have a large cerebellar hemispheric mass. The patient underwent excision of the mass, and analysis of frozen sections suggested the presence of an astrocytic tumor with pilocytic features; therefore gross-total resection was performed. Once the definitive diagnosis of a cryptococcal abscess was obtained, medical treatment with antifungal medications led to the resolution of all symptoms and the normalization of serum titers. Cryptococcoma is a rare cause of ring enhancing lesions in the cerebellum, even in apparently immunocompetent patients. The authors' experience with this case and the patient's postoperative care lead them to advocate resection of large isolated cryptococcomas of the CNS, especially those situated in the posterior fossa.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Cerebellar Diseases / diagnosis*
  • Cerebellar Diseases / drug therapy
  • Cerebellar Diseases / surgery
  • Child
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / drug therapy
  • Cryptococcosis / surgery
  • HIV Seronegativity
  • Humans
  • Immunocompetence*
  • Magnetic Resonance Imaging*
  • Male
  • Neurosurgical Procedures*
  • Tomography, X-Ray Computed*
  • Treatment Outcome

Substances

  • Antifungal Agents