Magnetic Resonance Imaging in Intracranial Paracoccidioidomycosis

Ac, Magalhães; Caramelli, Paulo; Silva, ED; La, Bacheschi; Ls, Lo; Menezes,; Shikanai-Yasuda, Maria Aparecida; Magalhães, Ana Tereza de Matos; Polachini, I.

doi:10.1111/jon199334216

Cited by 18 publications

(11 citation statements)

References 6 publications

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“…20 Therefore, necrotic lesions in PCM may resemble pyogenic abscesses, and proton MR imaging with spectroscopy being a noninvasive technique can help distinguish the lesions. 36,37 Similar to Reis et al, 33 we found a high peak of the lipids and choline in all cases.…”

Section: Discussionsupporting

confidence: 89%

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Júnior¹,

Amorim

Baldon

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS:We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS:Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with .2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of .2 cm. CONCLUSIONS:The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.ABBREVIATIONS: PCM ¼ paracoccidioidomycosis; CT ¼ computed tomography; MRI ¼ magnetic resonance imaging; CNS ¼ central nervous system; DSC ¼ dynamic susceptibility contrast; DCE ¼ dynamic contrast enhanced; rCBV ¼ relative cerebral blood volume; Gd ¼ gadolinium P aracoccidioidomycosis (PCM) is a fungal infection, which is endemic in Latin America and is mainly caused by the thermodimorphic fungus Paracoccidioides spp, which primarily attacks the lungs and has a potential to disseminate to other organs. 1 Recently described are 4 other species of the genus Paracoccidioides apart from P brasiliensis: P lutzii, P restrepiensis, P venezuelensis, and P Americana. 2,3 Paracoccidioides spp inhabits primarily the soil and causes autochthonous infection from southern Mexico to northern Argentina. 4-6 Most reported cases (approximately 80%) are from Brazil, and the rest are mainly from Venezuela, Colombia, and Argentina. [6][7][8][9][10][11][12][13][14] The criterion standard for the diagnosis of PCM consists of demonstrating the presence of the fungus as multiple budding cells in clinical or tissue specimens. Nevertheless, serologic tests and imaging examinations such as CT, MR imaging, and x-rays also play an important role in the diagnosis and evaluation of the disease. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] CNS involvement is more common than it was once believed, and the disease can affect the CNS, ranging from 1% to 27.27% of cases. [18][19][20][21][22][23][24][25] Although the brain form of PCM is usually an outcome of hematogenous or lymphatic dissemination of a primary focus, it is not necessarily followed by disseminated PCM; in a few cases, it is the only location of the fungus in the body. 26 Our purpose was to describe the clinical and radiologic data (CT ...

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Section: Discussionsupporting

confidence: 89%

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Júnior¹,

Amorim

Baldon

et al. 2019

AJNR Am J Neuroradiol

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“…However, the presence of low signal intensity on the T2-weighted sequence suggests the presence of hemoglobin degradation products. [46] The analysis of the lipid peak by spectroscopy of proton MR may indicate the neurological involvement by paracoccidioidomycosis,[4] notably in patients with concomitant risk and pulmonary involvement signals.…”

Section: Resultsmentioning

confidence: 99%

“…[12] Neuroparacoccidioidomycosis (NPCM) can occur in parenchymal and/or meningeal forms, and parenchymal pseudotumoral is the most frequently observed. [3610] Neurological involvement usually occurs in the context of chronic infection, however, it can also occur alone. [17] Although literature reports NPCM with variable incidence,[17] in recent years, with the widespread use of neuroimaging methods, it has become more common than earlier expected; in some samples, it occurs in up to 36% of the cases.…”

Section: Introductionmentioning

confidence: 99%

Pseudotumoral neuroparacoccidioidomycosis of the posterior fossa: A case report and review of the literature

Yamashita

et al. 2017

Surg Neurol Int

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Background:Paracoccidioidomycosis is a systemic mycosis of significant importance in some Latin American countries. The widespread use of neuroimaging methods has shown that involvement of the central nervous system was more frequent than previously reported. The most common form of occurrence of neuroparacoccidioidomycosis is the pseudotumoral one. The authors report a case of pseudotumoral neuroparacoccidioidomycosis localized in the posterior fossa.Case Description:A 49-year-old single man, rural worker, born and raised in Laranjal Paulista-SP, was admitted to the hospital with 3 months history of bilateral occipital headache every day. Along with a history of active smoking and previous use of alcohol, the patient reported personal history of mild occipitotemporal injury 3 months ago. The patient was submitted to computed tomography in a 16-row multidetector scanner, which revealed a nodular hypodense lesion with a ring-enhancement and associated perilesional edema in the left cerebellar hemisphere. Radiological workup was initiated to investigate the eventual primary neoplastic site.Conclusion:The analysis of the lipid peak by spectroscopy of proton magnetic resonance may indicate the neurological involvement by paracoccidioidomycosis, notably in patients with concomitant risk and pulmonary involvement signals.

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“…3 Clinical and laboratorial findings of neuroparacoccidioidomycosis are nonspecific, and the symptoms of cranial hypertension and localized neurological deficits predominate. 4 There are 2 forms of brain presentation: granulomatous (or pseudotumoral) and meningeal. The meningeal form is characterized by small cortical nodules and subarachnoid exudation.…”

Section: Discussionmentioning

confidence: 99%

Proton Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging Findings in a Patient with Central Nervous System Paracoccidioidomycosis

Faria

Dabus

Zanardi

et al. 2004

Journal of Neuroimaging

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The authors describe a patient with brain paracoccidioidomycosis whose magnetic resonance image (MRI) showed multiple hypointense lesions on T2-weighted images with peripheral enhancement after gadolinium injection. Single-voxel proton magnetic resonance spectroscopy (1H-MRS) of one of the lesions showed 2 peaks at 0.9 and 1.32 ppm, corresponding to lipid signals, indicating intense necrosis. The other characteristic peaks of 1H-MRS were undifferentiated from baseline. These findings, although not specific, may help to differentiate fungal abscess from tumoral lesions and other types of abscess.

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Magnetic Resonance Imaging in Intracranial Paracoccidioidomycosis

Cited by 18 publications

References 6 publications

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Pseudotumoral neuroparacoccidioidomycosis of the posterior fossa: A case report and review of the literature

Proton Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging Findings in a Patient with Central Nervous System Paracoccidioidomycosis

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