A Case of Brainstem Cryptococcoma Causing Pontine Stroke in an Immunocompetent Male
Iffat Jabeen1, Armin Maghsoudlou2
1Staten Island University Hospital, 2Staten Island University Hospital, Northwell Health
Background:
Cryptococcus is an invasive fungal disease seen in immune compromised individuals and usually present as meningitis when involved in the Central Nervous System. Cerebral cryptococcoma is a rare form of cryptococcal infection which is often misdiagnosed. Literature reviews showed most of them are located in frontal lobe, parietal lobe or basal ganglia. The involvement of pons only has been extremely rare. There are cases of cryptococcal meningitis causing ischemic stroke due to vasculitis but this case was complicated by perforator infarct adjacent to the lesion.
Results:
Case presentation:
We are going to discuss a 58 years old immunocompetent male who initially presented with dizziness and double vision. MRI of brain showed small acute infarct in right paramedian pons with adjacent edema out of proportion to the infarct. The contrast showed ring enhancing lesion. The patient returned after 4 months with severe headache and double vision. Repeat MRI of brain showed slightly enlarged ring enhancing lesion in right ventral pons. CSF study was positive for Cryptococcus neoformans both times.
Conclusions:
Diagnosis of cryptococcoma is often challenging especially in immunocompetent individuals where the clinical suspicion is low. There have been case reports where it has been misdiagnosed as neoplasm, tumefactive demyelinating disease and stroke. Therefore, causing delays in treatment leading to increased mortality and morbidity. This discussion indicates that physicians should have low threshold to suspect cryptococcoma in immunocompetent individual with ring enhancing lesion as timely intervention can save lives from this invasive fungal disease.