Paracoccidioidomycosis in the Central Nervous System

Paracoccidioidomycosis is a systemicmycosis caused by the Paracoccidioides brasiliensis fungus, which is endemic in Latin America. Brazil is the country with the highest number of cases. The affection of the central nervous system (CNS), a potentially fatal condition, occurs in 12% of the cases. The following forms of presentation are identified:meningeal, which is unusual;meningoencephalitic; and pseudotumoral, the latter two being more frequent. Imaging tests are essential for the diagnosis, but the histological identification of the fungus is required for confirmation of the pathology. The clinical picture depends on the neuraxial location.We present a case of amale rural worker, with expansive lesions in the CNS compatible with paracoccidioidomycosis.

Complex nasal reconstruction after paracoccidioidomycosis infection - Case report

Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

Paracoccidioidomicose em hemisfério cerebral e tronco encefálico: relato de caso / Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report / Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report

Relata-se sobre um homem de 36 anos com passagem quatro anos antes pela selva amazônica. Admitido após seis meses do aparecimento progressivo de tetraparesia, ataxia de marcha, disfagia, disartria, dispnéia e soluço. A ressonância magnética revelou lesão parietoccipital à direita e no bulbo, sendo esta última maior. Investigações para tuberculose e síndrome da imunodeficiência adquirida tiveram resultados negativos. Foi submetido a microcirurgia da lesão do bulbo. O estudo anatomopatológico revelou paracoccidioidomicose. Recebeu tratamento com anfotericina B até 2100 mg, e sulfametoxazol-trimetoprim por três meses, e fisioterapia. Voltou às atividades após seis meses do término do tratamento. Comenta-se sobre a participação do sistema imunológico e das citocinas (interleucinas.

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines.

Paracoccidioidomicosis cutanea asociada a seminoma / Paracoccidiodomycosis cutaneous associated with seminoms

Paciente de 35 años, oriundo de Paraguay, con una masa palpable indolente en el hemiabdomen derecho, que fue extirpada con diagnóstico de seminoma. Además, presentaba una lesión ulcerosa en la región escápulovertebral izquierda, cuyo examen micológico directo y cultivo fueron compatibles con Paracoccidioides brasiliens. No se hallaron otras manifestaciones cutáneomucosas relevantes radiografía de torax normal. Desde el punto de vista dermatológico recibió itraconazol con evolución favorable de la lesión. Se interpretó como paracoccidioidomicosis crónica, clinicamente unifocal cutánea, asociada a seminoma clásico

Osteomielite blastomicótica costal localizada ocasionando sépsis e tratamento cirúrgico / Localized costal blastomicotic osteomyelitis leading to sepsis and its surgical treatment

Os autores apresentam um caso de osteomielite de 7ª e 8ª costelas em hemitórax direito, sem comprometimento pulmonar evidente, com evoluçao progressiva para abscesso de parede torácica e sépsis. Costectomias parciais imediatas e antibioticoterapia endovenosa foram o tratamento de escolha, com análise histopatológica óssea revelando presença maciça de colônias de Paracoccidioides brasiliensis e, complementaçao com tratamento medicamentoso específico estabeleceu critérios de cura. O presente trabalho evidencia a raridade da localizaçao fúngica, a dificuldade clínica na investigaçao diagnóstica, devido a ausência de pneumopatia prévia aparente, e a importância do exame microscópico na conduçao da escolha terapêutica adequada.

Intramedullary spinal cord paracoccidioidomycosis: report of two cases

Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs, lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion). The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B.He progressively developed paresthesia and tactile/pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion). The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma). The preoperative diagnosis of intramedullary paracoccidioidomycotic granulonias is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.

Thoracic intraspinal paracoccidioidomycosis: case report

Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.

Paracoccidioidomicose com envolviemnto palpebral e conjuntival / Paracoccidioidomycosis with palpebral and conjunctival involvement-Repot of 4 cases and review of the literature

Os autores relatam quatro casos de Paracoccidioidomicose palpebral e conjuntival. Descrevem as lesöes oculares, o acometimento sistêmico quando presente e o tratamento. A literatura sobre o assunto é revisada

Abdomen agudo inflamatorio por blastomicose sul-anericana.Relato de caso / Inflamatory acute abdomen by paracoccidioidomycosis:a case report

E descrito um caso de abdomen agudo inflamatorio, devido a uma perfuraçao jejunal causada por comprometimento intestinal de Blastomicose Sul-americana. Atraves de revisao da literatura, sao tecidos comentarios sobrea doença de base, enfatizando a forma intestinal e suas complicaçoes clinico-cirurgicas

Paracoccidioidomicose linfático-abdominal - Contribuiçäo ao seu estudo / Paracoccidoidomicosis. The contribution to the study of lymphatic-abdominal form

Fifty-seven patients of paracoccidioidomycosis with lymfatic abdominal form were analized during the period of January, 1968 to December, 1980 at the Clinic Hospital of Federative University of Goiás. Thirty-seven cases were followed up by us under an internment regime and out patient services for at least three years. The others patients were observed by tropical pathologic staffs of the team and we had access to them during the identical period. The study was retrospective in twenty cases and in a prospective form in thirty-seven cases which we personally conducted the programed studies with rare exceptions. These patients were methodically studied in relation to the aspects: 1.Clinical epidemiology. 2.Immunology and immunopathology. 3.Subsidiary examination...