Disseminated Paracoccidioidomycosis with a Single Brainstem Lesion

Corti, Marcelo; Trione, Norberto; Risso, Domenico; Soto, Isabel; Villafañe, María F.; Yampolsky, Claudio; Negroni, Ricardo

doi:10.1177/197140091002300416

Cited by 12 publications

(21 citation statements)

References 15 publications

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“…The first two cases of PCM associated with HIV infection were reported in 1989 [10]. Since then, PCM/HIV coinfection occurrence has been reported as small case-series in endemic areas in Brazil [11,12,13], and in isolated cases reports in Colombia and Argentina [14,15]. Two retrospective case-control studies have been conducted up until the present date.…”

Section: Resultsmentioning

confidence: 99%

Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review

Almeida

Peçanha-Pietrobom

Colombo

2018

JoF

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Paracoccidioidomycosis (PCM) is an endemic mycosis found in Latin America that causes systemic disease mostly in immunocompetent hosts. A small percentage of PCM occurs in immunocompromised patients where low clinical suspicion of the infection, late diagnosis, and uncertainties about its management are factors that negatively impact their outcomes. We conducted a literature review searching reports on PCM associated to HIV, cancer, maligned hemopathies, solid organ transplantation, and immunotherapies, in order to check for peculiarities in terms of natural history and challenges in the clinical management of PCM in this population. HIV patients with PCM usually had low T CD4+ cell counts, pulmonary and lymph nodes involvement, and a poorer prognosis (≈50% mortality). Most of the patients with PCM and cancer had carcinoma of the respiratory tract. Among maligned hemopathies, PCM was more often related to lymphoma. In general, PCM prognosis in patients with malignant diseases was related to the cancer stage. PCM in transplant recipients was mostly associated with the late phase of kidney transplantation, with a high mortality rate (44%). Despite being uncommon, reactivation of latent PCM may take place in the setting of immunocompromised patients exhibiting clinical particularities and it carries higher mortality rates than normal hosts.

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Section: Resultsmentioning

confidence: 99%

Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review

Almeida

Peçanha-Pietrobom

Colombo

2018

JoF

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“…The 18 reports left provided 44 cases. 1,4,16,17,23,[25][26][27][28][29][30][31][32][33][34][35][36][37] The information available were categorized and the results are in ►Table 1.…”

Section: Discussionmentioning

confidence: 99%

Neuroparacoccidioidomycosis: Case Report and Literature Review

Morais¹,

Georgeto

Haddad

et al. 2018

Arq Bras Neurocir

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Introduction Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis, and it can compromise the central nervous system (CNS) in 10-27% of all cases. Case Report A 31-year-old man presented to the Emergency Department with headache, left-sided weakness, clonus at the ankle and a positive Babinski sign. Head computed tomography (CT) and magnetic resonance imaging (MRI) scans showed a 5.1 Â 3.8 cm lobulated lesion with areas of liquefaction in the right centrum semiovale. Discussion Central nervous system PCM can mimic a brain tumor, and most cases are diagnosed by biopsy of the lesion. The treatment includes antibiotics, but some cases require surgery. Conclusion Due to high morbimortality rates, the diagnosis must be considered, and early treatment started in patients who live in rural regions endemic for PCM when a ring-enhancing mass associated with perilesional edema is observed on MRI scans.

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“…Apart from gliomas (grade II–IV), Primitive Neuro-ectodermal Tumors (PNET) ( 9 , 10 , 12 ) and rarely germ cell tumors (including germinomas and teratomas) can present as diffuse infiltrative brainstem tumors; the management of these tumor entities is different than for gliomas. Non-malignant conditions presenting as brainstem lesions include neurodegenerative conditions (Alexander disease, acute demyelinating encephalomyelitis, central pontine myelinolysis) and infections (such as paracoccidioidomycosis) ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, a survey conducted among neurosurgeons revealed that there was no consensus regarding what constitutes a typical DIPG on MRI ( 18 ). The differential diagnosis for a brain stem tumor in a child with unusual presentation and atypical findings on neuroimaging include embryonal tumors like ATRT, PNET, and non-malignant lesions like infections, neurodegenerative conditions and hemangioblastomas ( 9 , 10 , 12 , 14 ); the management of these conditions is entirely different than for gliomas. Focal brainstem tumors usually have insidious onset, prolonged latency and atypical clinical features like failure to thrive, emesis etc.…”

Section: Introductionmentioning

confidence: 99%

DIPG in Children – What Can We Learn from the Past?

2015

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Brainstem tumors represent 10–15% of pediatric central nervous system tumors and diffuse intrinsic pontine glioma (DIPG) is the most common brainstem tumor of childhood. DIPG is almost uniformly fatal and is the leading cause of brain tumor-related death in children. To date, radiation therapy (RT) is the only form of treatment that offers a transient benefit in DIPG. Chemotherapeutic strategies including multi-agent neoadjuvant chemotherapy, concurrent chemotherapy with RT, and adjuvant chemotherapy have not provided any survival advantage. To overcome the restrictive ability of the intact blood–brain barrier (BBB) in DIPG, several alternative drug delivery strategies have been proposed but have met with minimal success. Targeted therapies either alone or in combination with RT have also not improved survival. Five decades of unsuccessful therapies coupled with recent advances in the genetics and biology of DIPG have taught us several important lessons (1). DIPG is a heterogeneous group of tumors that are biologically distinct from other pediatric and adult high grade gliomas (HGG). Adapting chemotherapy and targeted therapies that are used in pediatric or adult HGG for the treatment of DIPG should be abandoned (2). Biopsy of DIPG is relatively safe and informative and should be considered in the context of multicenter clinical trials (3). DIPG probably represents a whole brain disease so regular neuraxis imaging is important at diagnosis and during therapy (4). BBB permeability is of major concern in DIPG and overcoming this barrier may ensure that drugs reach the tumor (5). Recent development of DIPG tumor models should help us accurately identify and validate therapeutic targets and small molecule inhibitors in the treatment of this deadly tumor.

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Disseminated Paracoccidioidomycosis with a Single Brainstem Lesion

Cited by 12 publications

References 15 publications

Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review

Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review

Neuroparacoccidioidomycosis: Case Report and Literature Review

DIPG in Children – What Can We Learn from the Past?

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