NMC case report journal最新文献

{"title":"Multidisciplinary Treatment for Multiple Dural Arteriovenous Fistulas/Arteriovenous Malformation Associated with Congenital Protein S Deficiency: A Case Report and Literature Review.","authors":"Shotaro Ogawa, Satoshi Koizumi, Takeru Hirata, Motoyuki Umekawa, Shigeta Fujitani, Yuki Shinya, Hideaki Ono, Satoru Miyawaki, Masako Nishikawa, Mineo Kurokawa, Nobuhito Saito","doi":"10.2176/jns-nmc.2025-0289","DOIUrl":"10.2176/jns-nmc.2025-0289","url":null,"abstract":"<p><p>Congenital protein S deficiency, caused by <i>PROS1</i> gene variants, is a hereditary thrombophilia associated with venous thrombosis. Cerebral venous sinus thrombosis can lead to dural arteriovenous fistula; however, the optimal management of dural arteriovenous fistula in this setting remains unclear. We present a 50-year-old man with multiple intracranial dural arteriovenous fistulas and an arteriovenous malformation associated with confirmed protein S deficiency. The patient had a prior history of thrombosis at the superior sagittal sinus and left transverse sinus treated with anticoagulation at age 41. Digital subtraction angiography at age 49 revealed a de novo left temporal arteriovenous malformation (Spetzler-Martin grade II), left parietal dural arteriovenous fistula (Cognard type III), and anterior skull base dural arteriovenous fistula (Cognard type III) while the superior sagittal sinus and left transverse sinus remained patent. The patient was referred to our hospital due to a residual nidus following arteriovenous malformation resection at a previous institution. Transarterial embolization using Onyx and n-butyl-2-cyanoacrylate achieved complete occlusion of the dural arteriovenous fistulas, and stereotactic radiosurgery using Gamma Knife was subsequently performed for the residual arteriovenous malformation. A thrombophilia workup revealed markedly reduced protein S activity and a homozygous <i>PROS1</i> p.Lys196Glu variant. Long-term oral anticoagulation was initiated, and no recurrence or new thrombotic events were observed during the 6-month follow-up period. This case highlights the importance of considering congenital thrombophilia in patients with multiple arteriovenous fistulas/arteriovenous malformations. Genetic testing combined with a multidisciplinary treatment strategy tailored to the underlying prothrombotic state can contribute to favorable clinical outcomes.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"577-586"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saccular Limited Dorsal Myeloschisis with a Short Stalk at the Base of the Sac Causing Spinal Cord Deviation out of the Spinal Canal.","authors":"Takato Morioka, Akiko Kanata, Toshiyuki Amano, Daisuke Inoue, Satoshi O Suzuki, Takafumi Shimogawa, Nobutaka Mukae, Koji Yoshimoto","doi":"10.2176/jns-nmc.2025-0246","DOIUrl":"10.2176/jns-nmc.2025-0246","url":null,"abstract":"<p><p>Saccular limited dorsal myeloschisis is a condition in which the spinal cord is tethered by a fibroneural stalk that links the cord to a saccular skin lesion, probably due to a small segmental failure of the disjunction between the neural and cutaneous ectoderm during primary neurulation. We previously reported that the dorsally bent cord deviated from the canal into the sac when the tethering effect of the limited dorsal myeloschisis stalk was strong. These cases of saccular limited dorsal myeloschisis should be prenatally differentiated from myelomeningoceles; however, this is complicated by the limited resolution of prenatal magnetic resonance imaging. Nevertheless, postnatal magnetic resonance imaging, including three-dimensional heavily T2-weighted imaging, to demonstrate the stalk linking the top of the bent cord to the sac dome is essential. We recently treated a patient who presented with a cord deviation to the sac due to a short stalk linking the rostral part of the bent cord to the base of the sac. While the sagittal and axial views of three-dimensional heavily T2-weighted imaging alone were insufficient to visualize the short stalk, the coronal view clearly demonstrated that the stalk ran almost parallel to it. During surgery, untethering the cord and completely returning it to the canal is important.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"559-564"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal Pituitary Gland Showing an Intratumoral Septal Structure in a Nonfunctioning Pituitary Neuroendocrine Tumor: Illustrative Case.","authors":"Masato Ushiki, Rei Yamaguchi, Masahiko Tosaka, Naoko Inoshita, Ayako Yamazaki, Takahiro Saito, Hiroya Shimauchi-Otaki, Kaoru Aishima, Tatsuya Shimizu, Satoshi Nakata, Hideaki Yokoo, Yuhei Yoshimoto, Soichi Oya","doi":"10.2176/jns-nmc.2025-0162","DOIUrl":"10.2176/jns-nmc.2025-0162","url":null,"abstract":"<p><p>Normal pituitary glands are usually found to be present in the periphery of tumors. Normal pituitary gland showing an intratumoral septal structure has not been sufficiently discussed. A 73-year-old man presented with a visual field disorder. Endocrinologically, his basal luteinizing hormone and follicle-stimulating hormone levels were elevated. Gadolinium-enhanced T1-weighted magnetic resonance imaging revealed a sellar tumor. A well-enhanced normal pituitary gland was found with a septum-like shape slightly to the right of the tumor in the coronal section, and the tumor seemed to have grown independently on the cavernous sinus and sellar sides. Endoscopic transsphenoidal surgery was performed. After removal of the main tumor on the left side, the normal pituitary gland wall was confirmed to be intact. We observed a crack-like hole in the septum-like structure of the pituitary gland. We removed the tumor on the right side using this hole in the septum-like normal pituitary gland. This case was thought to have arisen because the adenoma perforated the normal pituitary gland during its development and then progressed outward, which is different from a double pituitary adenoma. In such cases, we should locate the hole in the septum-like structure of the normal pituitary gland and remove the tumor laterally progressing from this hole during endoscopic surgery.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"553-558"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Superior Ophthalmic Vein Thrombosis Resulted in Posterior Fossa Venous Congestion in a Case of Cavernous Sinus Dural Arteriovenous Fistula: Successful Treatment with Direct Interruption Surgery.","authors":"Yoshiro Yamada, Kota Kurisu, Masaki Ito, Toshiya Osanai, Taku Sugiyama, Miki Fujimura","doi":"10.2176/jns-nmc.2025-0294","DOIUrl":"10.2176/jns-nmc.2025-0294","url":null,"abstract":"<p><p>Cavernous sinus dural arteriovenous fistulas are generally considered to have a benign clinical course, as spontaneous thrombosis of the fistula or draining veins can result in regression of the lesion. However, we encountered a rare case in which this hemodynamic change led to rapid neurological deterioration, necessitating microsurgical intervention. A 72-year-old woman presenting with chemosis and exophthalmos was diagnosed with a cavernous sinus dural arteriovenous fistula. Cerebral angiography revealed 2 venous drainage routes: the superior ophthalmic vein anteriorly and the superior petrosal sinus towards the petrosal vein posteriorly. Approximately 2 weeks after diagnosis, while awaiting elective endovascular treatment, the patient developed spontaneous thrombosis of the superior ophthalmic vein. This redirected shunt flow exclusively into the petrosal vein, leading to venous congestion in the posterior fossa. Consequently, the patient experienced rapid neurological deterioration accompanied by brain edema in the cerebellum and brainstem. Furthermore, the loss of transvenous access rendered curative endovascular treatment unfeasible. The patient was therefore treated with urgent microsurgical interruption of the petrosal vein via a retrosigmoid approach. This resulted in complete neurological recovery and angiographic obliteration of the cavernous sinus dural arteriovenous fistulas. This case highlights the importance of close observation while waiting for the intervention for cavernous sinus dural arteriovenous fistulas with cortical venous reflux, given the risk of spontaneous hemodynamic change. It also underscores the role of microsurgical intervention as a salvage option when endovascular treatment becomes unfeasible.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"565-570"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Surgical Management of Symptomatic Trans-sellar Encephalocele: Two Case Reports and a Review of the Literature.","authors":"Hoai Thi Phuong Dinh, Kosaku Amano, Shinichiro Koizumi, Yukihiro Matsuyama, Kazuhiko Kurozumi, Takakazu Kawamata","doi":"10.2176/jns-nmc.2025-0222","DOIUrl":"10.2176/jns-nmc.2025-0222","url":null,"abstract":"<p><p>Trans-sellar encephalocele is a rare subtype of basal encephalocele characterized by herniation of neural tissue through a defect in the sellar floor, extending into the sphenoid sinus or nasopharynx. Due to its deep anatomical location and proximity to critical neurovascular and endocrine structures, trans-sellar encephalocele presents significant diagnostic and surgical challenges. We report two adult cases of symptomatic trans-sellar encephalocele with progressive visual impairment, both successfully treated via endoscopic endonasal surgery. In addition, to contextualize these cases, we conducted a comprehensive literature review of 47 previously reported symptomatic trans-sellar encephalocele that was surgically treated in the neurosurgical field over the past quarter century, resulting in a total 49 patients (33 males, 16 females). Clinical characteristics, imaging findings, surgical approaches, and outcomes were analyzed. Of the 49 patients, the common symptoms included nasal obstruction (59.2%), endocrine dysfunction (46.9%), cerebrospinal fluid leakage (30.6%), and visual impairment (24.5%). The majority (69.4%) were diagnosed at age six or younger. Surgery was performed primarily via transnasal approaches (49.4%). Outcomes were available in 44 cases; 81.8% experienced symptom resolution or improvement. In our two cases, postoperative imaging confirmed the reduction of the trans-sellar encephalocele and cessation of cerebrospinal fluid inflow. Visual symptoms improved without recurrence or complications. Early diagnosis and tailored surgical intervention are essential for optimizing outcomes in trans-sellar encephalocele. The endoscopic endonasal approach enables safe and effective reduction of the trans-sellar encephalocele while preserving critical structures. Modifying of cerebrospinal fluid dynamics appears to play a key role in halting symptom progression. Long-term follow-up and further studies are warranted to establish standardized management strategies.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"531-540"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ascending Perineural Spread of a Parotid Gland Adenoid Cystic Carcinoma Masquerading as a Local Recurrence of Skull Base Meningioma: Illustrative Case.","authors":"Daisuke Sato, Satoru Miyawaki, Satoshi Kiyofuji, Takuya Yoshida, Yudai Hirano, Atsuhito Nakayama, Masaki Suzuki, Yuki Saito, Taichi Kin, Nobuhito Saito","doi":"10.2176/jns-nmc.2025-0206","DOIUrl":"10.2176/jns-nmc.2025-0206","url":null,"abstract":"<p><p>The skull base is an intricate interface between the cranium and the face. Both intracranial and extracranial pathologies can occur at this location. Although the tumor origin is clear in most cases, certain extracranial tumors may mimic primary intracranial pathologies. A 48-year-old woman with a history of resection of a right tentorial meningioma 17 years earlier presented with worsening right facial palsy. No obvious enlargement of the parotid gland was noted. Imaging revealed a residual tentorial meningioma and a homogenously enhancing mass extending alongside the right facial nerve. The patient underwent several biopsies, and the diagnosis of adenoid cystic carcinoma arising from the parotid gland was made. She subsequently underwent carbon-ion radiation therapy and remained stable for 28 months after surgery. The representative case reiterates the importance of evaluating both intracranial and extracranial pathologies when a clinician encounters skull base tumors, especially those with perineural spreading. The tendency of meningiomas to involve the trigeminal nerve while sparing the facial nerve may provide a clue for the differential diagnosis.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"541-545"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Intracranial Ewing Sarcoma Arising from the Cavernous Sinus in an Older Woman with a History of Intensive Breast Cancer Treatment: A Case Report.","authors":"Tomoki Kawano, Fumitaka Matsumoto, Shinji Yamashita, Nobuyuki Oguri, Keiichi Akizuki, Takumi Tomonaga, Yuri Akiyama, Yoshihito Kadota, Yoshinao Oda, Minako Azuma, Atsushi Yamashita, Yoshiko Okita","doi":"10.2176/jns-nmc.2025-0138","DOIUrl":"10.2176/jns-nmc.2025-0138","url":null,"abstract":"<p><p>A 72-year-old woman with a history of breast cancer presented with left oculomotor nerve palsy. Magnetic resonance imaging revealed a progressive mass lesion in the cavernous sinus. Initially, Tolosa-Hunt syndrome and metastatic brain tumor from breast cancer were suspected; however, radiological differentiation proved challenging. Pathological examination confirmed the diagnosis of primary intracranial Ewing sarcoma. The tumor exhibited progressive growth, and Gamma Knife radiosurgery was performed. After treatment, tumor shrinkage and symptomatic improvement were observed. Ewing sarcoma typically occurs in children and young adults; however, the safety and efficacy of chemotherapy in older populations remain largely unstudied. In this older patient, the rare location of the tumor within the cavernous sinus posed challenges to surgical resection. Chemotherapy was administered at a reduced dose of 50%, with limited side effects. After 7 cycles of chemotherapy, tumor showed further shrinkage, and no recurrence was observed. This case demonstrates that, even in rare tumors with unestablished chemotherapy protocols for older patients, satisfactory outcomes can be achieved with accurate pathological diagnosis and a multidisciplinary treatment approach.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"525-530"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Eagle Syndrome in Elderly Patients Diagnosed by Dynamic Magnetic Resonance Angiography: A Case Report and Literature Review.","authors":"Hideki Nakajima, Yu Sato, Koichi Hakozaki, Tetsushi Yago, Kazuhiko Tsuda, Hidenori Suzuki","doi":"10.2176/jns-nmc.2025-0175","DOIUrl":"10.2176/jns-nmc.2025-0175","url":null,"abstract":"<p><p>Dynamic assessment by computed tomography angiography or digital subtraction angiography is important for the diagnosis of vascular eagle syndrome, although these require the use of contrast media. Magnetic resonance angiography with neck flexion and extension, named dynamic magnetic resonance angiography, can dynamically evaluate the relationship between the internal carotid artery and the styloid process with no use of contrast media. A 74-year-old male with chronic kidney disease was rushed to our hospital due to recurrent infarction in the left cerebral hemisphere. Magnetic resonance angiography in the neutral neck position showed no abnormality in the left internal carotid artery, but computed tomography revealed bilateral elongated styloid process. Dynamic magnetic resonance angiography was performed to show that the left internal carotid artery was compressed by the styloid process during neck flexion but not during neck extension. Carotid ultrasound revealed a thrombus in the high cervical portion of the left internal carotid artery. Styloidectomy was performed, and cerebral infarction has not recurred since then. Dynamic magnetic resonance angiography may be a useful diagnostic modality without using contrast media for vascular eagle syndrome.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"519-524"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Clazosentan Therapy for Subarachnoid Hemorrhage after Coil Embolization of Ruptured Posterior Cerebral Artery Aneurysm in a Patient with Moyamoya Disease: A Case Report.","authors":"Haruto Uchino, Taku Sugiyama, Masaaki Hokari, Yoshitaka Yamaguchi, Toshiya Osanai, Miki Fujimura","doi":"10.2176/jns-nmc.2025-0205","DOIUrl":"10.2176/jns-nmc.2025-0205","url":null,"abstract":"<p><p>Moyamoya disease is a progressive steno-occlusive cerebrovascular disorder that may be complicated by intracranial aneurysms, particularly, in the posterior circulation, which are at higher risk of rupture than those in the general population. Clazosentan, a selective endothelin A receptor antagonist, has been approved in Japan for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. However, cerebral hemodynamics after subarachnoid hemorrhage and safety of clazosentan in patients with moyamoya disease remain unknown. We report the case of a 46-year-old man with bilateral moyamoya disease who presented with severe subarachnoid hemorrhage caused by a ruptured saccular aneurysm in the right P2 segment of the posterior cerebral artery. Coil embolization was successfully performed, and clazosentan (10 mg/hr), along with cilostazol, was administered to prevent vasospasm. Fluid balance was carefully managed, and no clazosentan-related adverse events were observed. Follow-up radiological examinations showed no evidence of cerebral vasospasm or ischemic lesions. The patient made a favorable recovery and was discharged with a modified Rankin scale score of 1. Four months later, revascularization surgery was performed to reduce hemodynamic stress and the risk of hemorrhage from choroidal collaterals. The aneurysm remained occluded, the choroidal channels regressed, and no recurrent strokes occurred during 1 year of follow-up. To the best of our knowledge, this is the first report of successful clazosentan therapy for aneurysmal subarachnoid hemorrhage in a patient with moyamoya disease. Careful perioperative management allowed the safe use of clazosentan without complications. Further studies are needed to evaluate its broader safety and efficacy in this population.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"505-509"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal Intracranial Cryptococcoma with Treatment Resistance, Recurrence, and Mortality: A Case Report and Literature Review.","authors":"Masashi Higashino, Eiji Kurihara, Ryuichi Kuroda, Satoshi Inoue, Te-Jin Lee, Takashi Mizowaki, Takayuki Nakasho, Daiki Tanabe, Naoya Takeda","doi":"10.2176/jns-nmc.2025-0209","DOIUrl":"10.2176/jns-nmc.2025-0209","url":null,"abstract":"<p><p>Intracranial cryptococcoma is an uncommon manifestation of central nervous system cryptococcosis. Imaging commonly shows ring-enhancing lesions that resemble malignant tumors radiologically. Early diagnosis and extended antifungal treatment are crucial for decreasing morbidity and enhancing outcomes. Treatment typically involves a minimum of six weeks of induction therapy, followed by 6-18 months of maintenance therapy. Limited information is available on the complete clinical progression in cases where remission is not attained with initial treatment. A 66-year-old immunocompetent man presented with ten ring-enhancing lesions in the brain parenchyma and an infiltrative lesion in the lungs. Complete resection of the largest lesion in the left frontal lobe confirmed a histopathological diagnosis of cryptococcoma. Despite receiving eight weeks of induction therapy with liposomal amphotericin B and oral flucytosine, exceeding standard recommendations, the lesions only partially regressed, failing to achieve complete remission. Fluconazole maintenance therapy was initiated. At five months, lesion recurrence was observed. Induction therapy was resumed for three weeks, followed by a switch back to fluconazole. However, the patient's level of consciousness deteriorated, making oral medication impossible. The patient died 15 months after the initiation of antifungal treatment. Cryptococcoma is a critical diagnostic complication. When chest imaging findings are not characteristic of a typical malignancy, a biopsy is essential before determining the appropriate treatment strategy. When lesions do not completely resolve after induction therapy, careful clinical and radiological follow-up is crucial because the risk of recurrence remains significant.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"511-518"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}