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 ...

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.

Paracoccidioidomycosis (PCM) is one of the most relevant systemic endemic mycoses in Latin American countries, especially in South American countries, with endemic and hyperendemic areas. The real burden of PCM may be underestimated because of a lack of compulsory case notification. Recent phylogenetic data revealed that Paracoccidioides brasiliensis comprises several cryptic species including P. brasiliensis and P. lutzii. However, the genetic biodiversity of Paracoccidioides does not affect the clinical manifestations or therapeutic response to therapy. Lung involvement is a common finding, especially in patients experiencing the chronic form of the disease, and, because of its similarities with tuberculosis, clinicians must be alert to the possibility of PCM in patients with chronic respiratory manifestations and epidemiological risk factors for this fungal disease.

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A 17-year-old man with normal blood pressure presented with acute bilateral blindness, and retro-orbital pain two days after treatment with tocilizumab (TCZ) for juvenile idiopathic arthritis. The diagnosis was posterior reversible encephalopathy syndrome (PRES), made after clinical examination and MRI (Figure). Tocilizumab was discontinued and the patient partially improved. To the best of our knowledge, there are no reports of this association (PRES and TCZ) in PubMed. This manuscript describes a new association between TCZ and PRES based on imaging findings, in which the patient presented with more severe imaging findings and did not have complete recovery of the symptoms 1,2,3 .

Various neuropathologies produce hyperintense signals on T2-weighted or fluid-attenuated inversion recovery sequences of the temporal lobes. Recognition of the distribution pattern and associated findings may narrow the spectrum of differential diagnoses or suggest a specific disease. This pictorial essay aims to illustrate the relatively common diseases that affect the temporal lobe, such as herpes simplex encephalitis, neurosyphilis, limbic encephalitis, postictal edema, neoplasia, and multiple sclerosis, as well as those that are less common, such as myotonic dystrophy type 1, CADASIL, and CARASIL, together with the particularities of each entity.

OBJECTIVE:The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS:The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS:The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS:In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.

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