Manifestações extrapulmonares da paracoccidioidomicose

Abstract

Costa MAB et al. Radiol Bras 2005;38(1):455245 res os primeiros locais acometidos. A partir daí pode haver disseminação do fungo para outros locais, tanto por via hematogênica como linfática(1) . Qualquer órgão do corpo pode ser acometido, porém as manifestações radiológi-cas mais importantes são observadas nos pulmões, linfonodos, supra-renais, ossos, tubo digestivo e sistema nervoso. Como as manifestações pulmonares têm sido mais relatadas na literatura, optamos por discutir os principais aspectos de imagem no acometimento extrapulmonar da paracoccidioidomicose. Neste trabalho os autores realizam um estudo revisional e iconográfico de pacientes portadores da paracoccidioidomicose disseminada, apresentando os principais achados radiográficos no sistema nervoso central, glândulas adrenais, sistema osteoarticular, ganglionar e trato digestivo destes pacientes. Os métodos de diagnóstico por imagem têm permitido uma abordagem mais precisa destes pacientes e se mostrado cada vez mais sensíveis na detecção de lesões, mesmo em pacientes assintomáticos. Na maioria dos casos essas alterações são inespecíficas, podendo simular tanto lesões neoplásicas como infecciosas crônicas, sendo muitas vezes indistinguíveis da tuberculose. Apesar destas alterações serem incaracterísticas e do diagnós-tico de certeza da paracoccidioidomicose só ocorrer após a confirmação micológica ou histológica do fungo, é possivel sugerir um diagnóstico preciso quando os achados de imagem forem analisados em um contexto clínico e epidemiológico pertinente. Unitermos: Paracoccidioidomicose; Sistema nervoso central; Adrenais; Osteoarticular; Digestivo; Linfonodos. SISTEMA NERVOSO CENTRALExtra-pulmonary manifestations of paracoccidioidomycosis. The authors present a review and iconographic study of patients with disseminated paracoccidioidomycosis, including the main radiographic findings seen in the central nervous system, adrenal glands, osteoarticular system, lymph nodes and digestive tract. Imaging diagnostic methods have allowed a more precise approach of these patients due to their high sensitivity in detecting lesions, even in asymptomatic patients. In most cases these abnormalities are unspecific, simulating either neoplasic or chronic infectious lesions, and sometimes difficult to distinguish from tuberculosis. Although these findings are nonspecific and only the mycologic and histologic fungus demonstration can confirm the diagnosis, they may suggest a presumptive one, when these imaging findings are considered in an appropriate clinical and epidemiological setting. Key words: Paracoccidioidomycosis; Central nervous system; Adrenals; Osteoarticular; Digestive; Lymph nodes. Resumo

Revisão radiológica de 173 casos consecutivos de paracoccidioidomicose

“…The bone lesions found in 4% of cases in this study were those already previously described as lytic lesions without sclerotic reaction (48)(49)(50)(51)(52) . They have predominated in long bones and clavicle.…”

“…The visceral involvement has predominated in the liver and spleen and lesions of suprarenal and central nervous system have been interpreted as rare complications. Some authors suggest that the central nervous system may occur more frequently (48) .…”

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante

“…(5) In the present case, radiological lung involvement was extensive, showing interstitial nodular pattern, fibrosis, and cavities, all of which have often been described in paracoccidioidomycosis (6)(7)(8) and in histoplasmosis. Mediastinal nodal involvement can lead to necrosis, (9) and this is due to paracoccidioidomycosis, given that chronic cavitary histoplasmosis does not usually cause mediastinal adenopathy. (10) In Uruguay, this is the first documented case of concomitant paracoccidioidomycosis and histoplasmosis, and we found no similar cases in hyperendemic areas.…”

Paracoccidioidomycosis in the spine: case report and review of the literature

“…17 In this study, the patient presented the clinical and epidemiological characteristics of the disease, which included: male gender, farm laborer in an endemic area and age over 40 years. [6][7][8][9][10][11][12][13][17][18][19] The patient needed to have become infected during his second decade of life, when he worked in the fields for 10 years in an After 36 months, the patient was seen to be clinically asymptomatic, and his blood inflammatory markers were within the normal range. These parameters are considered to be the most important healing criteria.…”