Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found

Transtornos depressivos associados à neurocisticercose: prevalência e correlaçöes clínicas / Depressive disorders associated with neurocysticercosis: prevalence and clinical correlations

Objetivo: Investigar a ocorrência e os fatores de risco para morbidade depressiva em uma amostra de 38 pacientes ambulatoriais com neurosisticercose. Métodos: O diagnóstico psiquiátrico baseou-se nos exames do estado mental atual e pregresso, respectivamente obtidos pelas entrevistas estruturadas do PSE-9 e SADS-L; as funçoes cognitivas foram avaliadas pelo MMS e pelo roteiro de Strub & Black (Mental Status Examination). Resultados: Transtornos depressivos foram o achado psiquiátrico mais frequente (63,1 por cento) entre os pacientes da amostra. Destes, 20 (52,6 por cento) mostravam-se deprimidos no momento da avaliaçao e 4 apresentaram depressao no passado. Entre os pacientes deprimidos, 16 preencheram critérios diagnósticos do DSM-III-R para transtorno orgânico do humor (k = 0,4). Antecedentes pessoais de depressao (p = 0,006), sinais de atividade da doença (p = 0,044) e ocorrência de hipertensao intracraniana (p=0,065) foram os parâmetros clínicos que se correlacionaram com a presença de depressao. Conclusoes: Tais achados, aliados à ausência de predomínio do sexo feminino entre os casos de depressao, sugerem etiologia orgânica. Os autores discutem essas observaçoes à luz da literatura sobre outros transtornos mentais orgânicos.

Ocorrencia de arterite, infartos cerebrais multiplos, displasia fibromuscular e aneurismas intracranianos em paciente com feocromocitoma. Relato de um caso / Occurrence of arteritis, multiple cerebral infarcts, fibromuscular dysplasia and intracranial aneurysms in a patient with pheochromocytoma.Report of a case

Uma paciente com 57 anos de idade, exibindo agitaçao psi comotora confusao mental e hipertensao arterial pregressa, portadora de feocromocitoma na glandula supra-renal esquerda, apresentou concomitantemente arterite, infartos cerebrais multiplos,displasia fibromuscular na arteria carotida internae aneurismas intracranianos. A presente associaçao poderia ocorrer de forma fortuita: entretanto, agressoes de celulas musculares por catecolaminas poderiam justificar alguns dos eventos vasculares encontrados nessa paciente