Uncommon presentation of intracranial cryptococcal infection mimicking tuberculous infection in two immunocompetent patients

Singapore Med J. 2009 Apr;50(4):e133-7.


Cryptococcal infection of the brain is commonly seen in immunocompromised patients but rarely considered as the differential diagnosis in immunocompetent patients. We present two cases of cryptococcosis involving the brain in immunocompetent patients, which strongly mimicked tuberculous infection in both conventional as well as advanced magnetic resonance (MR) imaging, and the disease was only confirmed after histopathological/cerebrospinal fluid serological study. One patient was a 52-year-old woman, and the second patient was a 23-year-old man. These two cases highlight the need for workup of fungal infections in immunocompetent patients from the tuberculous endemic regions, even when the imaging is highly suspicious of tuberculous lesions. The imaging findings in advanced MR imaging techniques such as diffusion, perfusion, susceptibility-weighted imaging and MR spectroscopy are discussed.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / administration & dosage
  • Antifungal Agents / administration & dosage
  • Cerebellar Diseases / diagnosis
  • Cerebellar Diseases / pathology
  • Cerebellar Diseases / surgery
  • Cryptococcus neoformans*
  • Diagnosis, Differential
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Flucytosine / administration & dosage
  • Humans
  • Immunocompetence*
  • Magnetic Resonance Imaging*
  • Magnetic Resonance Spectroscopy
  • Male
  • Meninges / pathology
  • Meningitis, Cryptococcal / diagnosis*
  • Meningitis, Cryptococcal / immunology
  • Meningitis, Cryptococcal / pathology
  • Meningitis, Cryptococcal / surgery
  • Middle Aged
  • Tomography, X-Ray Computed*
  • Tuberculosis, Meningeal / diagnosis*
  • Tuberculosis, Meningeal / immunology
  • Tuberculosis, Meningeal / pathology
  • Tuberculosis, Meningeal / surgery
  • Young Adult


  • Antifungal Agents
  • Amphotericin B
  • Flucytosine