Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report
Arq. bras. neurocir
;
40(2): 195-199, 15/06/2021.
Artículo
en Inglés
| 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.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Paracoccidioidomicosis
/
Huésped Inmunocomprometido
/
Infecciones Fúngicas del Sistema Nervioso Central
/
Antifúngicos
Tipo de estudio:
Estudio pronóstico
Límite:
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Arq. bras. neurocir
Asunto de la revista:
Cirurgia
/
Neurocirugía
Año:
2021
Tipo del documento:
Artículo
País de afiliación:
Brasil
Institución/País de afiliación:
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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