A 29-year-old man who underwent open-heart surgery for primum atrial septal defect and mitral regurgitation after mitral valvuloplasty presented with a 5-day history of severe headache and diplopia. Contrast-enhanced computed tomography revealed a 2.7-cm soft-tissue lesion in the nasopharynx occupying the left fossa of Rosenmüller (Fig. 1a, arrow). The mass bled easily during nasopharyngoscopy, suggestive of nasopharyngeal carcinoma (Fig. 1b). A biopsy reported numerous cryptococcal yeasts (Fig. 1c, arrows). A lumbar puncture demonstrated high opening pressure (50 cmH2O), 8 leukocytes/mm3, and high protein levels (47 mg/dL). Cryptococcus neoformans was cultured from blood and cerebrospinal fluid; a serum cryptococcal antigen titer was 1:256. A western blot was positive for human immunodeficiency virus (HIV) antibodies; CD4 cells were 26/μL (9.2 %). The patient was treated successfully with intravenous amphotericin B (1 mg/kg per day) and oral flucytosine (100 mg/kg per day) for 14 days. Subsequently, the patient was prescribed fluconazole (400 mg/day) in consolidation therapy for 8 weeks, followed by fluconazole (200 mg/day) as a maintenance therapy.
Cryptococcus, an important pathogen among HIV-infected patients, mainly involves the lungs and central nervous system (CNS) [1]. Acquired immune deficiency syndrome patient (AIDS) patients with cryptococcal meningitis demonstrated common extraneuronal involvement, as high as 50 % [2]. Moreover, C. neoformans could be cultured from the nasopharynx up to 50 % of AIDS patients complicated with cryptococcosis [3]. Both domestic and wild animals (cats and koalas) are susceptible to cryptococcal infections; typically, the upper and lower respiratory tracts, CNS, and skin are commonly affected [4]. To our knowledge, this is the first account of a patient presenting with a cryptococcoma mimicking nasopharyngeal cancer. Failure to recognize the early clinical manifestations associated with cryptococcal infection in HIV-infected patients may lead to inappropriate treatment and poor prognosis; successful treatment of this case was attributable to early diagnosis and broad-spectrum antibiotic administration.
References
Warkentien Tyler, Crum-Cianflone Nancy F. An update on cryptococcosis among HIV-Infected persons. Int J STD AIDS. 2010;21(10):679–84.
Eng RHK, Bishburg E, Smith SM, Kapila R. Cryptococcal infections in patients with acquired immune deficiency syndrome. Am J Med. 1986;81:19–23.
Sukroongreung S, Eampokalap B, Tansuphaswadikul S, Nilakul C, Tantimavanich S. Recovery of Cryptococcus neoformans from the nasopharynx of AIDS patients. Mycopathologia. 1998;143:131–4.
Mandrioli L, Bettini G, Marcato PS, Benazzi C, Della Salda L, Krockenberger MB, Jensen HE, Jensen HE. Central Nervous System Cryptococcoma in a Cat. J Vet Med A. 2002;49:526.
Conflict of interest
On behalf of all the authors, the corresponding author states that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lin, GY., Lin, TY., Lee, JT. et al. An isolated cryptococcoma mimicking nasopharyngeal cancer. Infection 43, 129–130 (2015). https://doi.org/10.1007/s15010-014-0705-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-014-0705-2