Central nervous system histoplasmosis mimicking tentorium meningioma

Ribeiro, Bruno Niemeyer de Freitas; Corrêa, Diogo Goulart; Marchiori, Edson

doi:10.1590/0037-8682-0379-2017

Cited by 2 publications

(3 citation statements)

References 2 publications

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“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Section: Resultsmentioning

confidence: 99%

“…Histoplasmomas were often multiple and located in the supratentorial compartment, with a higher frequency of supratentorial lesions in the parietal lobe, while infratentorial lesions were commonly localised in the brainstem. Meningeal patterns exhibited both pachymeningeal 22,24 and leptomeningeal enhancement, 63 particularly in the basal skull and tentorium 33,35 . Hydrocephalus was typically communicating, although there was one case with an intraventricular lesion 64 .…”

Section: Resultsmentioning

confidence: 99%

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Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Oliveira

Kruschewsky

Sekiguchi

et al. 2023

Mycoses

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Background:The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series.Objectives: Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease. Methods:We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions.Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs. Results:We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months.Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole. Conclusion:Central nervous system histoplasmosis usually presents subacute-tochronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were

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“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Oliveira

Kruschewsky

Sekiguchi

et al. 2023

Mycoses

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“…23 Solitary histoplasma abscesses can mimic intracranial neoplasms and CNS inflammatory processes on presentation and imaging, which necessitates thorough assessment of risk factors and diagnostic workup to avoid delays in appropriate management (►Table 2). [58][59][60] CSF analysis for histoplasma brain abscesses is unfortunately poorly sensitive and can be misleading. In a case series' subanalysis of intraparenchymal histoplasma mass lesions, only 27% of patients exhibited CSF pleocytosis, 42% had elevated CSF protein levels and all patients had normal CSF glucose levels.…”

Section: Histoplasmosismentioning

confidence: 99%

Fungal Infections of the Central Nervous System

Jia

Thakur

2019

Semin Neurol

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Fungal central nervous system infections present in a myriad of clinical manifestation and remain a significant diagnostic challenge. Presenting symptoms, cerebrospinal fluid analysis, conventional fungal serum markers and imaging correlates of disease are seldom sensitive or specific; fungal culture growth or histopathologic analysis are often required for definitive diagnoses but limited by feasibility. Novel diagnostic tools (such as the cryptococcal antigen and next-generation sequencing) have increased diagnostic potency when available but require further studies to define their utility.Invasive fungal infections are an emerging health threat in the setting of increased immunomodulatory treatments, advancements in transplant medicine and increased world-wide travel. Therefore, strong clinical suspicion from epidemiologic clues, clinical progression and presence of CNS dissemination risk factors must be exercised to pursue broad diagnostic workups and rapidly initiate medical and surgical management. This article will describe the epidemiology, clinical presentations, diagnostic approach and therapeutic interventions for fungal infections in the central nervous system.

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Central nervous system histoplasmosis mimicking tentorium meningioma

Abstract: FIGURE: Magnetic resonance imaging revealed a mass on the tentorium (arrows) caused by histoplasmosis that shows iso/hypointensity on T1-and T2-weighted images (A and B, respectively) with exuberant contrast enhancement on a gadolinium-enhanced, T1-weighted image (C).

Cited by 2 publications

References 2 publications

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Fungal Infections of the Central Nervous System

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