Central nervous system histoplasmosis mimicking tentorium meningioma

A 37-year-old immunocompetent female resident of Rio de Janeiro, Brazil, presented with a 2-month history of headache, without fever or any other symptoms. Results of serology for HIV and a venereal disease research laboratory test were both negative. Analyses of cerebrospinal fluid yielded normal findings. Brain magnetic resonance imaging (MRI) revealed a mass on the tentorium showing iso/hypointensity on T1- and T2-weighted images (Figure A and Figure B, respectively) with exuberant contrast enhancement (Figure C). Meningioma located in the tentorium was the main diagnosis. After surgical treatment, a histopathological diagnosis of histoplasmosis was made. Central nervous system (CNS) histoplasmosis commonly occurs in immunocompromised patients with disseminated infection^1,2. The most common manifestation of CNS involvement is subacute or chronic meningitis^1,2. Histoplasmosis mimicking a meningioma is exceptional and, in some cases, presents with the dural tail sign. This sign is seen on MRI as thickening of the dura mater, enhanced by venous contrast, which resembles a tail extending from a mass, and is generally related to meningiomas, which are the most common tumors of the meninges. In conclusion, histoplasmosis should be included in the differential diagnosis of CNS masses.

FIGURE
Magnetic resonance imaging revealed a mass on the tentorium (arrows) caused by histoplasmosis that shows iso/hypointensity on T1- and T2-weighted images (A and B, respectively) with exuberant contrast enhancement on a gadolinium-enhanced, T1-weighted image (C).

Acknowledgments

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE, et al. Histoplasmosis with deep CNS involvement: case presentation with discussion and literature review. J Neurol Surg Rep. 2015;76(1):e167-72.
• ²
  Azizirad O, Clifford DB, Groger RK, Prelutsky D, Schmidt RE. Histoplasmoma: isolated central nervous system infection with Histoplasma capsulatum in a patient with AIDS Case report and brief review of the literature. Clin Neurol Neurosurg. 2007;109(2):176-81.

Publication Dates

• Publication in this collection
  Sep-Oct 2018

History

• Received
  29 Sept 2017
• Accepted
  05 Apr 2018