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

Abstract

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.

Systematic review of neuroparacoccidioidomycosis: The contribution of neuroimaging

“…One more study was excluded after a review of the full text because of insufficient patient data. In conclusion, we included 34 manuscripts, with 104 new cases of NPCM 2,6,12,14–44 . We present the flow diagram in Figure 1.…”

Reporte de dos casos de neuro-paracoccidiomicosis

“…La afección del sistema nervioso central, también puede darse en forma aislada como el caso reportado por Riechelmann et al (10) , en un varón de 55 años, fumador, sin comorbilidades conocidas, remitido al equipo de neurocirugía por antecedente de crisis epiléptica única una semana antes del ingreso hospitalario seguida de hemiparesia derecha progresiva. La tomografía computarizada de cráneo y la resonancia magnética cerebral mostraron una lesión expansiva intraaxial que afectaba al lóbulo parietal izquierdo, asociada a un extenso edema y un efecto compresivo regional, inicialmente se manejó como un absceso.…”

“…Las manifestaciones neurológicas frecuentes incluyen signos motores, hipertensión intracraneal, convulsiones y dolor de cabeza. Las masas pseudotumorales granulomatosas múltiples en los hemisferios cerebrales, el cerebelo y el tronco encefálico son las formas y localizaciones más frecuentes (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) .…”

A Case of Neuroparacoccidioidomycosis in Houston, Texas

“…Neuroparacoccidioidomycosis, however, is quite rare, noted in about 10-27% of all cases [7][8][9]. It presents in one of three forms: a meningeal form, a combined meningeal pseudo-tumoral form, and a parenchymal pseudo-tumoral form, the latter of which is more common [10].…”