Thoracic intraspinal paracoccidioidomycosis: case report

Abstract

-Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.KEY WORDS: paracoccidioidomycosis, central nervous system, spinal cord. Paracoccidioidomicose intramedular torácica: relato de casoRESUMO -Lesões intramedulares causadas pelo Paracoccidioides brasiliensis são raras. O quadro clínico de lesão expansiva medular é inespecífico e uma intervenção cirúrgica com fins diagnósticos e terapêuticos constitui o único método de diagnóstico eficiente. Os autores relatam um caso em uma mulher de 45 anos com lesão medular ao nível torácico. Descrevem-se os achados clínicos, cirúrgicos e de ressonância magnética nesta situação incomum. (Table 1). We describe a case of thoracic intramedullary paracoccidioidomycotic granuloma. CASE REPORTSTN, a 45 year-old woman, was admitted in our Service on July 14, 1994, with complaints of progressive lower limbs weakness and paresthesias. Her symptoms started 30 days before her admission. At that time, she underwent a lumbal myelography with normal findings. Five months before, she was submitted to laminectomy and L4-L5 discectomy in another Service. She told us about a lip ulceration three years ago. A local biopsy of the ulceration and pathological examination disclosed the presence of fungi. She was medicated (drug unknown) for some weeks with complete resolution of the oral lesion. She was otherwise a healthy person, without reference to any other systemic diseases, including the respiratory tract. Her general physical examination was normal.

Central Nervous System Paracoccidioidomycosis: an overview

“…The frequency of CNS involvement in PCM is extremely variable, from 9.65% to 25.45% [1,[15][16][17][18][19]. There have been an increasing number of reports of NPCM, most of which involve neurosurgical or anatomopathological findings [1,16,17,[19][20][21][22][23][24][25][26].…”

“…The first report of NPCM in the spinal cord was published by Canelas et al in 1951. Since then, there have been 13 published cases, all of them from Brazil [13,16,21,22,24,26,[33][34][35][36][37]. The most frequently involved spinal cord levels are thoracic (58%), cervical (25%), and both (8%).…”

Medullary Paracoccidioidomycosis Treated Successfully with Oral Itraconazole

“…We also found one case not indexed in the two databases, the first case being of medullary infection by Paracoccidioides brasiliensis described in the literature, and one case of extradural spinal cord compression. 2,4,[6][7][8][9][10][12][13][14][15][16][17] Of the nineteen cases described, the majority underwent laminectomy and approach to the expanding lesion. The medical treatment used anfotericin B in three cases, anfotericin plus sulfadiazine in one case, only sulfadiazin in two cases, sulfamethoxazole plus trimethoprim in two cases, sulfamethoxazole plus trimethoprim plus fluconazole in one case, only fluconazole in one case, and cetaconazole in one case.…”

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

“…Analysis of the available data shows an increasing number of reports on NPCM, most of which correspond to neurosurgical or to anatomopathologic findings. 1,[3][4][5][6][7][8][9][10][11][12][13] The NPCM diagnosis frequently is difficult, and a clinical suspicion frequently occurs when a patient with systemic PCM has some neurologic sign or symptom. Cerebrospinal fluid (CSF) alterations and neuroradiologic methods (computed tomography scan or nuclear magnetic resonance) are useful for diagnoses but are not specific.…”