“…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.…”
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by thermally dimorphic fungi of two main species: Paracoccidioides brasiliensis (P. brasiliensis) and Paracoccidioides lutzii (P. lutzii). 1 The distribution of PCM includes subtropical regions and endemic countries with mild temperature and high and constant humidity. 2,3 It is considered the most important deep mycosis in Latin America, 4,5 especially in Brazil, responsible for the majority of reported cases. 3,6
“…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.…”
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by thermally dimorphic fungi of two main species: Paracoccidioides brasiliensis (P. brasiliensis) and Paracoccidioides lutzii (P. lutzii). 1 The distribution of PCM includes subtropical regions and endemic countries with mild temperature and high and constant humidity. 2,3 It is considered the most important deep mycosis in Latin America, 4,5 especially in Brazil, responsible for the majority of reported cases. 3,6
“…There have been various studies of the systemic and CNS changes in patients with PCM ( 2 , 10 - 12 , 14 - 19 , 24 , 25 , 28 - 30 ) . However, to our knowledge, this is the first conventional imaging study analyzing the behavior of NPCM lesions after treatment, as well as the largest imaging follow-up study of patients with NPCM.…”
Objective: To describe the clinical and radiological evolution of lesions during and after treatment in patients diagnosed with neuroparacoccidioidomycosis (NPCM). Materials and Methods: This was a retrospective study of the medical records, computed tomography scans, and magnetic resonance imaging (MRI) scans of patients with NPCM treated between September 2013 and January 2022. Results: Of 36 cases of NPCM, eight were included in the study. One patient presented only with pachymeningeal and skull involvement, and seven presented with pseudotumors in the brain. Collectively, the eight patients presented with 52 lesions, of which 46 (88.5%) were supratentorial. There were 32 lesions with a diameter ≤ 1.2 cm, of which 27 (84.4%) disappeared during the treatment. In three cases, there were lesions > 1.2 cm that showed a characteristic pattern of evolution on MRI: an eccentric gadolinium contrast-enhanced nodule, with a subsequent decreased in the size and degree of contrast enhancement of the lesions. Conclusion: In NPCM, supratentorial lesions seem to predominate. Lesions ≤ 1.2 cm tend to disappear completely during treatment. Lesions > 1.2 cm tend to present with a similar pattern, designated the “Star of Bethlehem sign”, throughout treatment.
“… 43 Recently, hippocampal sclerosis associated with PCM has also been described as a neuroimaging manifestation of this disease, associated with granulomas. 44 Figure 3 A 31-year-old woman presented with cough and seizures. ( A ) Chest radiograph revealed bilateral pulmonary consolidations, more conspicuous in the central areas (“butterfly wing” pattern).…”
Paracoccidioidomycosis (PCM) is a infection caused by the thermodimorphic fungus
Paracoccidioides
spp. (P.
lutzii
and, mainly,
P. brasiliensis
). This infection predominantly affects rural male workers aged between 30 and 50 years old who deal with soil on daily activities. Clinically, the disease is classified as acute/subacute phase, which evolves rapidly, secondary to dissemination of the fungus through to the phagocytic-mononuclear system, leading to fever, weight loss, and anorexia, associated with hepatosplenomegaly and lymphadenopathy, which can be complicated with suppuration and fistulization; and chronic phase, which corresponds to 74% to 95% of symptomatic cases, with a common pulmonary involvement. Central nervous system involvement is almost always a characteristic of the chronic form. Inhalation is the most common route of primary infection, usually affecting the lungs, forming the primary complex. From the primary complex, hematogenic dissemination can occur to any organ, including the brain and spinal cord. Although PCM of the central nervous system diagnosis is usually based on histopathological analysis and the imaging features are not specific for PCM, computed tomography and magnetic resonance imaging can demonstrate evidences of granuloma, abscess, meningitis, or a combination of these lesions, contributing to a preoperative diagnosis, especially when considered in conjunction with epidemiology. In this article, we review the pathophysiology, clinical manifestations and imaging aspects of neuro-PCM.
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