Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

LetterLetter

Uncommon Presentation of Intracranial Cryptococcoma in an Immunocompetent Patient

R.R. Batista and E.L. Gasparetto
American Journal of Neuroradiology February 2012, 33 (2) E26; DOI: https://doi.org/10.3174/ajnr.A2988
R.R. Batista
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
E.L. Gasparetto
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

We read with special interest the article by Saigal et al,1 who described unusual brain MR imaging findings in an immunocompetent patient with cryptococcosis. The authors emphasized that the imaging findings of cryptococcosis affecting the brain in immunocompetent patients can be different from the more commonly described findings in immunocompromised patients.

We present a similar case of a 37-year-old man with a 2-month history of headache and 1 episode of seizures. There was no history of fever or any additional medical illness. Neurologic examination showed bilateral papilledema. CSF study findings were normal, except for marginally elevated protein levels. All the laboratory tests results, including an HIV test, were normal. Brain MR imaging showed an intra-axial right frontoparietal mass lesion hypointense on T1-weighted images and heterogeneously hyperintense on FLAIR/T2-weighted images, with surrounding vasogenic edema and heterogeneous enhancement (Fig 1A, -B). No high perfusion or restricted diffusion was noted, and MR spectroscopy (TE = 30 ms) demonstrated a high choline peak, low N-acetylaspartate (NAA), and a peak of lipids/lactate (Fig 1C). The patient underwent stereotactic biopsy, and histopathology revealed a granulomatous lesion with the typical appearance of cryptococcoma. The patient was treated with amphotericin B, intravenous steroids, and anticonvulsants.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Axial FLAIR (A) and sagittal postcontrast T1-weighted MR (B) images demonstrate a heterogeneously enhancing right parietal mass, with surrounding vasogenic edema. MR spectroscopy (TE = 30 ms) (C) shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) (at 3.2 ppm) and lactate (Lac) and/or lipid peaks (at 1.33 ppm).

Cryptococcosis is an opportunistic fungal infection that affects the central nervous system in patients with HIV and other immunocompromised patients; it is rarely seen in immunocompetent patients.1 Central nervous system infection can be either meningeal or parenchymal. Intraparenchymal cryptococcomas are masslike lesions that can masquerade as a brain tumor,1,2 as seen in our case. Despite the absence of signs of high perfusion, the very high choline/NAA ratio (>3) and the conventional MR imaging findings could allow the diagnostic hypothesis of a brain tumor. Although there are no unequivocal cutoff metabolite signal-intensity ratios that clearly distinguish neoplastic from nonneoplastic conditions, a choline/NAA cutoff ratio of 2:2, as seen in our case, has been described in the literature to differentiate high-grade from low-grade neoplasms and nonneoplastic conditions.3

In conclusion, corroborating the observation of Saigal et al,1 the appearance of a Cryptococcus organism central nervous system infection in an immunocompetent patient may be different from that commonly encountered in the immunocompromised patient, making the preoperative diagnosis of this fungal infection a challenge.

References

  1. 1.↵
    1. Saigal G,
    2. Post MJ,
    3. Lolayekar S,
    4. et al
    . Unusual presentation of central nervous system cryptococcal infection in an immunocompetent patient. AJNR Am J Neuroradiol 2005; 26: 2522–26
    Abstract/FREE Full Text
  2. 2.↵
    1. Tien RD,
    2. Chu PK,
    3. Hesselink JR,
    4. et al
    . Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. AJNR Am J Neuroradiol 1991; 12: 283–89
    Abstract/FREE Full Text
  3. 3.↵
    1. Al-Okaili RN,
    2. Krejza J,
    3. Wang S,
    4. et al
    . Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults. Radiographics 2006; 26: 173–89
    CrossRefPubMed
  • © 2012 by American Journal of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 33 (2)
American Journal of Neuroradiology
Vol. 33, Issue 2
1 Feb 2012
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Uncommon Presentation of Intracranial Cryptococcoma in an Immunocompetent Patient
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
R.R. Batista, E.L. Gasparetto
Uncommon Presentation of Intracranial Cryptococcoma in an Immunocompetent Patient
American Journal of Neuroradiology Feb 2012, 33 (2) E26; DOI: 10.3174/ajnr.A2988

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Uncommon Presentation of Intracranial Cryptococcoma in an Immunocompetent Patient
R.R. Batista, E.L. Gasparetto
American Journal of Neuroradiology Feb 2012, 33 (2) E26; DOI: 10.3174/ajnr.A2988
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • References
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • Reply:
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref (5)
  • Google Scholar

This article has been cited by the following articles in journals that are participating in Crossref Cited-by Linking.

  • Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients
    Stenio Bruno Leal Duarte, Mariana Mari Oshima, João Vitor do Amaral Mesquita, Felipe Barjud Pereira do Nascimento, Paula Christina de Azevedo, Fabiano Reis
    Radiologia Brasileira 2017 50 6
  • Seizure in isolated brain cryptococcoma: Case report and review of the literature
    Laura Brunasso, Roberta Costanzo, Antonio Cascio, Ada Florena, Gianvincenzo Sparacia, Domenico Gerardo Iacopino, Giovanni Grasso
    Surgical Neurology International 2021 12
  • Cerebral cryptococcoma successfully treated by isavuconazole in an immunocompetent patient: A case report
    Luis Guilherme Ramanzini, Sara Diógenes Peixoto de Medeiros, Lara Maria Fujita Vieira Lima, Marcéu Veríssimo Ramos dos Santos, Elizeu Alves Herbster, Guilherme Dourado Aragão Sá Araújo, Victor Oliveira Araújo, Jessica Maria Bezerra Braga, Diogo Pasquali Nones, Júlio César Claudino dos Santos
    Radiology Case Reports 2023 18 3
  • Middle cerebral artery infarction, A rare complication of intracranial cryptococcoma in an immunocompetent patient: A case report and literature review
    Ying-Ching Li, Chun-Chia Tseng, Shuo-Chi Chien, Sheng-Han Huang, Tin-Wei Chang, Chun-Ting Chen, Po-Hsun Tu, Zhuo-Hao Liu, Yin-Cheng Huang
    Frontiers in Surgery 2023 10
  • Intracranial Cryptococcoma Mimicking Stroke or Brain Tumor: A Diagnostic Challenge in an Immunocompetent Patient
    Ryotaro Otsuka, Taro Komuro, Haruki Yamashita, Yuto Mitsuno, Manabu Kurosawa, Satoshi Horiguchi
    Cureus 2025

More in this TOC Section

  • Letter to the Editor regarding “Automated Volumetric Software in Dementia: Help or Hindrance to the Neuroradiologist?”
  • Reply:
  • Brain AVM’s Nidus: What if We Hadn’t Understood Anything?
Show more LETTERS

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire