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Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report
Cambruzzi, Eduardo; Pêgas, Karla Lais; Bezerra Cortês Nascimento, Gabriella; Andrade Muller da Silva, José Nathan; Brandelli Zandoná, Natália; Pegoraro Kus, William; Lourezon Schiavo, Felipe; Lourezon Schiavo, Felipe; Cezimbra dos Santos, Samir.
  • Cambruzzi, Eduardo; Department of Pathology, Universidade Federal do Rio Grande do Sul. Department of Pathology, Hospital Santa Rita, Complexo Hospitalar Santa Casa. Department of Pathology, Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Pêgas, Karla Lais; Department of Pathology, Hospital Santa Rita, Complexo Hospitalar Santa Casa. Department of Pathology, Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Bezerra Cortês Nascimento, Gabriella; Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Andrade Muller da Silva, José Nathan; Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Brandelli Zandoná, Natália; Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Pegoraro Kus, William; Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Lourezon Schiavo, Felipe; Department of Neurosurgery, Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Lourezon Schiavo, Felipe; Department of Neurosurgery, Grupo Hospitalar Conceição. Porto Alegre, RS. BR
  • Cezimbra dos Santos, Samir; Department of Neurosurgery, Grupo Hospitalar Conceição. Porto Alegre, RS. BR
Arq. bras. neurocir ; 40(2): 195-199, 15/06/2021.
Article in English | LILACS | ID: biblio-1362266
ABSTRACT
Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CTscans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 3.2 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.
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Full text: Available Index: LILACS (Americas) Main subject: Paracoccidioidomycosis / Immunocompromised Host / Central Nervous System Fungal Infections / Antifungal Agents Type of study: Prognostic study Limits: Humans / Male Language: English Journal: Arq. bras. neurocir Journal subject: Cirurgia / Neurosurgery Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: Department of Neurosurgery, Grupo Hospitalar Conceição/BR / Department of Pathology, Hospital Santa Rita, Complexo Hospitalar Santa Casa/BR / Department of Pathology, Universidade Federal do Rio Grande do Sul/BR / Grupo Hospitalar Conceição/BR

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Full text: Available Index: LILACS (Americas) Main subject: Paracoccidioidomycosis / Immunocompromised Host / Central Nervous System Fungal Infections / Antifungal Agents Type of study: Prognostic study Limits: Humans / Male Language: English Journal: Arq. bras. neurocir Journal subject: Cirurgia / Neurosurgery Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: Department of Neurosurgery, Grupo Hospitalar Conceição/BR / Department of Pathology, Hospital Santa Rita, Complexo Hospitalar Santa Casa/BR / Department of Pathology, Universidade Federal do Rio Grande do Sul/BR / Grupo Hospitalar Conceição/BR