Javier Bava

CNS Cryptococcoma in an HIV-Positive Patient

This is the first case of brain cryptococcoma in an AIDS patient reported in Argentina. The patient was a 28-year-old white heterosexual man with AIDS who presented with altered mental status, seizures, visual hallucinations, headache, and fever without significant focal neurological deficit. He had a lumbar puncture, and was treated for cryptococcal meningitis. Subsequent brain CT scanning and MRI disclosed a mass lesion in the occipital lobe. Histopathological examination of biopsy was compatible with cryptococcoma, and tissue culture revealed Cryptococcus neoformans. Resolution of the mass and edema resulted after treatment with intravenous amphotericin B for six weeks, which was followed with maintenance oral fluconazole. Intracranial mass is an uncommon complication in AIDS patients with cryptococcosis, and cryptococcoma should be considered as differential diagnosis of brain mass lesion in these patients. The etiologic diagnosis is necessary because central nervous system (CNS) toxoplasmosis, lymphoma, and tuberculoma can produce similar clinical syndromes and MRI or CT findings to cryptococcoma. Also, these pathologies may coexist with meningeal cryptococcosis.

Giemsa and Grocott in the recognition of Histoplasma capsulatum in blood smears

OBJECTIVE To facilitate the recognition of intracellular yeasts of Histoplasma capsulatum and differentiate it from Leishmania amastigotes and other parasites, using the combination of Giemsa and a rapid modification of Grocott stains to peripheral blood smears in a hematological study. METHODS The combination of both stains was applied consecutively (first Grocott and then Giemsa) to previously fixed peripheral blood smears. Microscopy was performed with 400× and 1 000×, the latter using immersion oil. RESULTS The yeasts of Histoplasma capsulatum were observed into the cytoplasm of leukocytes as brownish oval elements, with 3-4 µm in diameter. CONCLUSIONS The combination of both techniques is a simple and fast method to facilitate recognition of intracellular yeasts and it is different from intracellular parasitic elements. Moreover, it allows distinguishing the cell elements that are in the microscopic preparations. It may be very helpful in those cases in which the presumptive diagnosis of histoplasmosis has not been established yet and where other more sophisticated methods are not available.