Itraconazole and fluconazole in three neuro-paracoccidioidomycosis patients / Itraconazol e fluconazol em 3 pacientes com neuro-paracoccidioidomicose (PBM) cerebral

ABSTRACT

Three paracoccidioidomycoses (OBM) patients Male, age 44,51 and 53 years old, form workers, heavy smokers, alcoholics were admitted in to Emílio Ribas Hospital, Såo Paulo, SP, with dyspnea, expectorative cough in all of them and evolutive cardiac edema in two C.O.P.D. inpatients. Hypertensive / nephropathy - 2, adenopathy - 2, clubbing finger, Cor pulmonale (C.O.P.D.), hepatoesplenomegaly and severe interstitial bilateral infiltrate lung lesions were related in 2 patients. Encephalopaty and cerebelar ataxia in one, focal convulsive crises, hypoastesia right arm and Mingazzini neurologic examens were observed in two patients. Paracoccidioides brasiliensis was recovered from bronchoscopy. Pulmonary function showed bronchodilator no response and 2 mixels test, hypergamaglobulinemia, increases seric level alcaline phosphatase in 3, policytemia in 2 and complement fixation reaction rancing from 1/8 to 1/64 with negative counter immunoelectrophoresis, like laboratorial examens. Berebral C.T. -scan confirmed active nodules in three and cerebelar abscess in one. Azoles therapy revealed one early deth and after 18 months the presence of active nocules (C.T.-scan skull) in 2 of all chronic lung PBM patients