An isolated cryptococcoma mimicking nasopharyngeal cancer

Excerpt

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.

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