Forma granulomatosa da criptococose cerebral: relato de caso

Luc Fobe, Jean; Buone, Mauro Livio De; Costa, Ricardo Borges Da

doi:10.1590/S0004-282X1995000500017

Resumos

A criptococose do sistema nervoso central na sua forma granulomatosa ou criptococoma é rara, sendo mais freqüente a forma meningítica ou meningoencefalítica. Apresentamos o case de um paciente de 56 anos, não portador da síndrome de imunodeficiência adquirida, com manifestação clínica inicial de síndrome de hipertensão intracraniana em decorrência de criptococoma occípito-parietal que foi removido cirurgicamente, seguido do tratamento medicamentoso com anfotericina-B e 5-fIuorocitosina. A fisiopatologia, o diagnóstico por imagem e o tratamento são revistos.

criptococose; cérebro; criptococoma; criptococose forma granulomatosa

Cryptococcal granuloma or toruloma of the central nervous system is very rare, meningoencefalitis or meningitis being most common. The authors present the case of an immunocompetent male patient of 56 years old with initial clinical symptoms of intracranial hypertension due to an occípito-parietal crytococcal granuloma that was removed surgically. The patients was treated post operatively with anphotericin-B and 5-fluorcytosine. Pathophysiology, neuroimaging, diagnosis and treatment of this rare entity are discussed.

cryptococcosis; brain; toruloma; cryptococcal granuloma

Forma granulomatosa da criptococose cerebral. Relato de caso

Cryptococcal granuloma of the brain: case report

Jean-Luc Fobe^I; Mauro Livio De Buone^II; Ricardo Borges Da Costa^III

^ICoordenador do Setor de Neurocirurgia; Serviço de Neurocirurgia e Patologia da AACD - Associação de Assistência à Criança Defeituosa -(Diretor Dr. Ivan Ferrareto)

^IIMédico Estagiário do Setor de Neurocirurgia; Serviço de Neurocirurgia e Patologia da AACD - Associação de Assistência à Criança Defeituosa -(Diretor Dr. Ivan Ferrareto)

^IIIMédico Patologista; Serviço de Neurocirurgia e Patologia da AACD - Associação de Assistência à Criança Defeituosa -(Diretor Dr. Ivan Ferrareto)

RESUMO

A criptococose do sistema nervoso central na sua forma granulomatosa ou criptococoma é rara, sendo mais freqüente a forma meningítica ou meningoencefalítica. Apresentamos o case de um paciente de 56 anos, não portador da síndrome de imunodeficiência adquirida, com manifestação clínica inicial de síndrome de hipertensão intracraniana em decorrência de criptococoma occípito-parietal que foi removido cirurgicamente, seguido do tratamento medicamentoso com anfotericina-B e 5-fIuorocitosina. A fisiopatologia, o diagnóstico por imagem e o tratamento são revistos.

Palavras-chave:criptococose, cérebro, criptococoma, criptococose forma granulomatosa.

SUMMARY

Cryptococcal granuloma or toruloma of the central nervous system is very rare, meningoencefalitis or meningitis being most common. The authors present the case of an immunocompetent male patient of 56 years old with initial clinical symptoms of intracranial hypertension due to an occípito-parietal crytococcal granuloma that was removed surgically. The patients was treated post operatively with anphotericin-B and 5-fluorcytosine. Pathophysiology, neuroimaging, diagnosis and treatment of this rare entity are discussed.

Key-words: cryptococcosis, brain, toruloma, cryptococcal granuloma.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 3-julho-1995.

Dr. Jean-Luc Fobe - Serviço de Neurocirurgia, AACD -Av. Prof. Ascendino Reis 724 - 04027-000 São Paulo SP Brasil. FAX 011 570 2781.

1. Baum GU, Schawarz J. Diagnostic and treatment of systemic myycoses. Med. Clin N Am, 1974, 58:661-669.
2. Berlin L, Pinus JH. False-negative antigen test results and cultures in nonimmunosuppressed patients. Arch Neurol 1989, 46:1312-1316.
3. Garcia AC, Weisberb AL, Lacorte JSW. Cryptococcal intracranial mass lesions: CT - pathologic considerations. Neurology 1985, 35: 731-734.
4. Heier LA, Bauer CJ, Scheartz L, Zimmerman RD, Morgello S, Deck MD. Large Virchow Robin spaces: MR - clinical correlations. AJNR 1989, 10 : 929-936.
5. Jungreis CA, Kanal E, Hirch WL, Martinez AJ, Moossy J. Normal perivascular spaces mimicking lacunar infarction: MR imaging. Radiology 1988, 169: 101-104.
6. Kanter SL, Friedman WA, Ongley JP. Pitfalls in the computed tomography mass lesions. Ann Intern Med 1981, 94: 382-388.
7. Keohane C, Galvin JR, Buckey FT. Cryptococcal granuloma of the brain. J Neurol Neurosurg Psychiatry 1990, 53: 1107-1108.
8. Livramento JA, Machado LR, Nóbrega JPS, Gomes HR, Vianna LS, Spina-França A. CSF in 85 patients with AIDS and CNS cryptococcosis. Arq. Neuropsiquiatr l992, 50:491-496.
9. Medoff G, Dismukes WE, Pappagianis DP, Diamond R, Gallis HA, Drutz D. Evaluation of new antifungal drugs for the treatment of systemic fungal infections. Clin Inf Dis 1992, 15(Suppl 1): 274-281.
10. Perject JR, Durack DT, Gallis HA. Cryptococcemia. Medicine 1983, 62: 98-109.
11. Sabetta JR, Andriole VT. Cryptococcal infection of the central nervous system. Med Clin N Am 1985, 69: 333-342.
12. Scott EN, Muchmore HG, Felton FG. Comparison of enzyme imunoassay and latex agglutation for detection of Cryptococcus neoformans antigen. Am J Clin Pathol 1980, 73: 790-795.
13. Selby RC, Lopes NM. Torulomas (Cryptococcal granulomata) of the central nervous system. J. Neurosurg 1973, 38:40-46.
14. Sugar AM. Cryptococcosis in the patient with AIDS. Mycopathologia 1991, 114: 153-157.
15. Tien DR, Chu KP, Hesselink RJ, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 patients. AJNR 1991, 12: 283-289.
16. Tress B, Davis S. Computed tomography of intracranial toruloma. Neuroradiology 1979, 17: 223-226.
17. Young FR, Gade G, Grinnell V. Surgical treatment for fungal infections in the central nervous system. J Neurosurg 1985, 63: 371-381.
18. Utz JP, Guarrigues IL, Sande MA et al. Therapy of cryptococcosys with a combination of flucytosine and amphotericin B. J Inf Dis 1975, 132:368-372.

Datas de Publicação

Publicação nesta coleção
08 Dez 2010
Data do Fascículo
Dez 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Baum GU, Schawarz J. Diagnostic and treatment of systemic myycoses. Med. Clin N Am, 1974, 58:661-669.

[2] 2. Berlin L, Pinus JH. False-negative antigen test results and cultures in nonimmunosuppressed patients. Arch Neurol 1989, 46:1312-1316.

[3] 3. Garcia AC, Weisberb AL, Lacorte JSW. Cryptococcal intracranial mass lesions: CT - pathologic considerations. Neurology 1985, 35: 731-734.

[4] 4. Heier LA, Bauer CJ, Scheartz L, Zimmerman RD, Morgello S, Deck MD. Large Virchow Robin spaces: MR - clinical correlations. AJNR 1989, 10 : 929-936.

[5] 5. Jungreis CA, Kanal E, Hirch WL, Martinez AJ, Moossy J. Normal perivascular spaces mimicking lacunar infarction: MR imaging. Radiology 1988, 169: 101-104.

[6] 6. Kanter SL, Friedman WA, Ongley JP. Pitfalls in the computed tomography mass lesions. Ann Intern Med 1981, 94: 382-388.

[7] 7. Keohane C, Galvin JR, Buckey FT. Cryptococcal granuloma of the brain. J Neurol Neurosurg Psychiatry 1990, 53: 1107-1108.

[8] 8. Livramento JA, Machado LR, Nóbrega JPS, Gomes HR, Vianna LS, Spina-França A. CSF in 85 patients with AIDS and CNS cryptococcosis. Arq. Neuropsiquiatr l992, 50:491-496.

[9] 9. Medoff G, Dismukes WE, Pappagianis DP, Diamond R, Gallis HA, Drutz D. Evaluation of new antifungal drugs for the treatment of systemic fungal infections. Clin Inf Dis 1992, 15(Suppl 1): 274-281.

[10] 10. Perject JR, Durack DT, Gallis HA. Cryptococcemia. Medicine 1983, 62: 98-109.

[11] 11. Sabetta JR, Andriole VT. Cryptococcal infection of the central nervous system. Med Clin N Am 1985, 69: 333-342.

[12] 12. Scott EN, Muchmore HG, Felton FG. Comparison of enzyme imunoassay and latex agglutation for detection of Cryptococcus neoformans antigen. Am J Clin Pathol 1980, 73: 790-795.

[13] 13. Selby RC, Lopes NM. Torulomas (Cryptococcal granulomata) of the central nervous system. J. Neurosurg 1973, 38:40-46.

[14] 14. Sugar AM. Cryptococcosis in the patient with AIDS. Mycopathologia 1991, 114: 153-157.

[15] 15. Tien DR, Chu KP, Hesselink RJ, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 patients. AJNR 1991, 12: 283-289.

[16] 16. Tress B, Davis S. Computed tomography of intracranial toruloma. Neuroradiology 1979, 17: 223-226.

[17] 17. Young FR, Gade G, Grinnell V. Surgical treatment for fungal infections in the central nervous system. J Neurosurg 1985, 63: 371-381.

[18] 18. Utz JP, Guarrigues IL, Sande MA et al. Therapy of cryptococcosys with a combination of flucytosine and amphotericin B. J Inf Dis 1975, 132:368-372.