Brain stem candidiasis mimicking cerebellopontine angle tumor

Background: Infectious process can mimic cerebral tumors. We present the first report of a fugal infection in brainstem mimicking cerebral tumors in the literature. Case Description: A 17-month-old boy presented with abnormal movements of his left arm and difficulty walking for 2 weeks. The MRI of the patient showed an enhancing partially cystic and partially solid mass in the right CP angle cistern, interpreting as CP tumor. On MRS, there was a decreased N-acetylaspartate/Creatine ratio and an elevated choline/Cr ratio. The patient underwent right retrosigmoid craniotomy and excisional biopsy. On the specimen, there were numerous fungal organisms consistent with Candida species. Our patient recovered completely after and 377-day voriconazole treatment. He was still quite well without neurologic sequelae at follow-up for 2 years. Conclusions: Brainstem candidiasis in immunocompetent host can masquerade the CP angle tumor. The MRI and MRS are not always diagnostic. Neurosurgical intervention is mandatory to relieve the mass effect in brainstem with high risk and achieve the pathologic diagnosis. Followed by voriconazole treatment, the patient could be treated successfully. (C) 2008 Elsevier Inc. All rights reserved.