An immunocompetent 49-year-old man with a disseminated infection

Ortiz, Silva; Wiesner, S; Cataño, Juan Carlos

doi:10.1016/j.ejim.2016.04.009

Cited by 1 publication

(5 citation statements)

References 4 publications

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“…[9] In the majority of NPCM cases, simultaneous lung impairment and common abnormalities (opacities, consolidations, nodules, or cavitations) are seen in chest X-rays. [2,8,11,12] Despite what the literature shows, the present case had no systemic manifestations of the disease. e symptoms regarding the disease can vary according to the site of the lesion in the brain.…”

Section: Discussioncontrasting

confidence: 70%

“…Other frequent symptoms are intracranial hypertension, ocular motility deficits and generalized seizures, or alteration of consciousness. [2,5,9,10,11] Our case followed the majority of findings in the literature, presenting with hemiparesis and generalized seizures.…”

Section: Discussionsupporting

confidence: 70%

“…Brazil is the country with the most cases of PCM in Latin America with a prevalence estimated at between 5.6 and 17.5%, with an age peak of 30-50 years of age. [1,2,9,11] e disease is caused by inhaling fungal spores, resulting in a primary pulmonary complex that can spread through the lymphatic and/or hematological pathways to various extrapulmonary foci. Initial infection is usually asymptomatic and rapidly resolves by itself, leaving residual lesions that may contain viable fungi for many years (latent or quiescent foci) that eventually reactivate (adult form -90% of cases) due to immunosuppression in tandem with a debilitating disease.…”

Section: Discussionmentioning

confidence: 99%

“…e microscopic findings in Grocott-Gomori's methenamine silver nitrate stain are characteristic and highly specific for PCM, with multiple budding and cells arranged in a shape similar to a ship's wheel or Mickey Mouse's ears, as happened to our patient. [2,4,5,6,8,9,11] It is possible to analyze circulating P. brasiliensis antigens (gp43 and gp70) in body fluids using inhibition enzyme-linked immunosorbent assay, which can be helpful for confirmation of the diagnosis of NPCM. [8] Antigen concentrations are higher in CSF (gp43 antigen higher than gp70) than in serum, with high sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…MRI spectroscopy showed lipid peaks (1.3 ppm) that could be useful to differentiate NPCM from other lesions such as pyogenic abscesses (where peaks of succinate at 2.4 ppm, acetoacetate at 1.9 ppm, and alanine at 1.4 ppm may be seen). [13] Treatment for PCM is mainly clinical with antifungal drugs such as trimethoprim/sulfamethoxazole (with low toxicity and easily availability) [11,12] in association with an azole agent such as itraconazole or fluconazole (the only azole that can cross the brain-blood barrier) as the therapy of choice for a period of 12-84 months according to the literature. [1,4,5,6,8,9] Immunocompromised or severely ill patients can be treated with amphotericin B and sulfadiazine.…”

Section: Discussionmentioning

confidence: 99%

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Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease

RIECHELMANN

Rodrigues

Avelar

et al. 2020

Surgical Neurology International

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Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery. Case Description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease. Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.

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Section: Discussioncontrasting

confidence: 70%