Cerebellar cryptococcoma in a patient with undiagnosed sarcoidosis : Case report

We describe a patient with undiagnosed sarcoidosis who presented with a rare isolated cerebellar cryptococcoma masquerading as a metastatic brain tumor. A 58-year-old man with a history of resected squamous cell carcinoma of the larynx and pulmonary nodules was found to have a left cerebellar lesion on neuroimaging after presenting with a 4-month history of occipital headaches. Neuroimaging revealed a large, lobulated, intra-axial, left cerebellar hemispheric mass with peripheral nodular enhancement, mild adjacent edema, and dense focal areas of calcification. The patient underwent a left suboccipital craniotomy for gross total resection of the left cerebellar mass. Pathological examination of the resected specimen demonstrated a cryptococcoma, which was confirmed with a positive cerebrospinal fluid cryptococcal antigen. Postoperative evaluation revealed pulmonary sarcoidosis. Central nervous system cryptococcoma is a rare infection that may present in a patient with no known history of immunosuppression and no clinical signs of infection. Diagnostically, this can be difficult to distinguish from a brain tumor. Central nervous system cryptococcoma is an opportunistic infection that typically occurs in the presence of an immunosuppressed state. Sarcoidosis should be considered a predisposing factor because patients with this underlying disease have an increased susceptibility to this central nervous system fungal infection.