Intracranial fungal mass imitating a high-grade glial lesion – is antifungal alone sufficient?

Background: Intracranial fungal mass is rare among immunocompetent individuals with variable presentation and management algorithms making it challenging to achieve optimal outcomes. Case Description: Herein, we report the presentation of a 34-year-old immunocompetent Pashtun female with acute-onset rapidly progressing generalized weakness, altered cognition, and motor and speech deficits. Although the radiological findings resembled a glioblastoma, the strong clinical suspicion of a fungal infection and her improvement on voriconazole treatment led to the decision to avoid surgical resection, thereby minimizing the risk of potential dissemination. Conclusion: Our case emphasizes that any deviation from the typical presentation of high-grade tumors must be reviewed with the need for surgical resection being evaluated on a case-to-case basis while prioritizing patient outcomes.