Neuroparacoccidioidomycosis with concomitant pulmonary and vocal cord lesions

Dias, Adriano Basso; Giugno, Cláudia Scherber; Scapineli, Jessica Oliboni; Tarso, Gabriel Pedro; Curtis, Rodrigo Miranda de; Lenhardt, Rene

doi:10.1590/0004-282x20180119

Cited by 1 publication

(12 citation statements)

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“…The prevalence of NPDM ranges from 4% to 15% of cases of systemic PDM. 1,4,10,12,13 Manifestations of the involvement of the CNS include headache, lethargy, raised intracranial pressure, and personality changes. Neuroparacoccidioidomycosis is most commonly associated with symptoms and signs of an expansive lesion in the brain (pseudotumorous form) or to a meningitic form.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,8,12,13,15 A chronic inflammatory infiltrate can be identified in the leptomeninges, and this infiltrate can extend along the Virchow-Robin space into the underlying brain tissue, especially in the hypothalamus. 2,5,8,12,13,15 A dimorphic fungus, PB forms oval to rounds yeasts with multiple buds at 37°C in tissues and in cultures. The fungus is a white mold composed of thin septate hyphae that produce chlamydoconidia, and, when cultured, it produces < 5 µm asexual propagules known as microconidia (probably the infectious particle).…”

Section: Discussionmentioning

confidence: 99%

“…3,5,12,13 Serological tests are also useful for the presumptive diagnosis of NPDM, and these tests can be used to monitor the response to the treatment too. 2,12,13,[16][17][18][19] The CSF analysis has both low sensitivity and low specificity. Gp43 and gp70 PB antigens in body fluids and in the CSF (inh-enzyme-linked immunosorbent assay [ELISA] method) can be helpful for the diagnosis of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis includes Coccidioides immitis (sporangia measuring 30 µm to 60 µm and containing 1 µm to 5 µm sporangiosporesit usually occurs as meningitis), Histoplasma capsulatum (a dimorphic, ovoid fungi, measuring 2 µm to 5 µm), and Cryptococcus neoformans (yeasts measuring 4 µm to 7 µm and exhibiting a mucinous capsule). 1,2,7,12,13,19,20,22 In the presence of the pseudotumorous form of NPDM, the differential diagnosis also includes neoplasms (primary and secondary), abscesses, tuberculosis, and neurocysticercosis. 7,12,13,19,20,[22][23][24] The therapy includes sulfonamides, amphotericin B and azoles (fluconazole, itraconazole, voriconazole).…”

Section: Discussionmentioning

confidence: 99%

“…On microscopy, paracoccidiodomycomas (pseudotumorous form) exhibit granulomas composed of epithelioid macrophages, Langhans giant cells, necrotic central areas, and lymphocytes. 2,5,8,12,13,15 A chronic inflammatory infiltrate can be identified in the leptomeninges, and this infiltrate can extend along the Virchow-Robin space into the underlying brain tissue, especially in the hypothalamus. 2,5,8,12,13,15 A dimorphic fungus, PB forms oval to rounds yeasts with multiple buds at 37°C in tissues and in cultures.…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report

Cambruzzi

Pêgas

Nascimento

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CT scans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 × 3.2 × 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.

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Section: Discussionmentioning

confidence: 99%