Paracoccidioidal Granulomatosis of the Brain

Minguetti, Guilberto; Madalozzo, Luiz E.

doi:10.1001/archneur.1983.04050020062013

Cited by 19 publications

(12 citation statements)

References 9 publications

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“…CNS involvement can take one of two forms: the most common is a granulomatous lesion, and the second rare form is an inflammatory meningeal reaction, which characterizes either acute or chronic basilar meningitis. The combination of both forms can be found in 23% of patients 1–3…”

Section: Discussionmentioning

confidence: 99%

“…Involvement of the central nervous system (CNS) with paracoccidioidomycosis (PCM) was first described in 1919 1, 2. PCM must always be considered in the differential diagnosis of both meningoencephalitis and expansive CNS lesions in endemic areas 1–3. We report on a case of PCM that presented with a midbrain mass lesion associated with Holmes' tremor.…”

mentioning

confidence: 97%

“…Paracoccidioidomycosis is a chronic infectious disease that may present with neurological signs/symptoms. Involvement of the central nervous system (CNS) with paracoccidioidomycosis (PCM) was first described in 1919 1, 2. PCM must always be considered in the differential diagnosis of both meningoencephalitis and expansive CNS lesions in endemic areas 1–3.…”

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Holmes' tremor and neuroparacoccidioidomycosis: A case report

et al. 2002

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Holmes' tremor and neuroparacoccidioidomycosis: A case report

et al. 2002

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“…Analysis of the available data shows an increasing number of reports on NPCM, most of which correspond to neurosurgical or to anatomopathologic findings. 1,[3][4][5][6][7][8][9][10][11][12][13] The NPCM diagnosis frequently is difficult, and a clinical suspicion frequently occurs when a patient with systemic PCM has some neurologic sign or symptom. Cerebrospinal fluid (CSF) alterations and neuroradiologic methods (computed tomography scan or nuclear magnetic resonance) are useful for diagnoses but are not specific.…”

Section: Paracoccidioidomycosis (Pcm) Is a Chronic Granulomatous Infementioning

confidence: 99%

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

et al. 2002

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Paracoccidioidomycosis (PCM) is a chronic granulomatous infectious disease, endemic in subtropical areas of Central and South America. The diagnosis of the central nervous system (CNS) involvement with PCM (neuroparacoccidioidomycosis [NPCM]) frequently is difficult. A definitive diagnosis usually is made by visualization or isolation of Paracoccidioides brasiliensis from CNS biopsy or necropsy material. In the present study, we determined the presence of anti-gp43 antibodies in the cerebrospinalfluid (CSF) of patients with CNS involvement in PCM by enzyme-linked immunosorbent assay (ELISA) in 9 cases of NPCM and 15 control cases. ELISA anti-gp43 was compared with double immunodiffusion (DID). ELISA anti-gp43 was positive in 8 (89%) of 9 CSF samples from patients with NPCM and negative in all CSF samples of the control group. DID was negative in all CSF samples from patients with NPCM and control samples. ELISA anti-gp43 in CSF samples is better than DID for the diagnosis of NPCM. It is a sensitive and specific diagnostic method and has high predictive values. To our knowledge, this is thefirst time ELISA anti-gp43 was applied to CSF.

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Novo tratamento para extenso granuloma paracoccidioidomicótico cerebral

Guerreiro

Chuluc

Branchini

1987

Arq. Neuro-Psiquiatr.

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Surgical treament and/or amphotericin B have been the treatment of choice for cerebral infections caused by the fungus Paracoccidioides brasiliensis 1,3,6,7,8,9,11,12,13,15,17 . We are reporting a new drug treatment for the encephalic form of paracoccidioidomycosis. P. brasiliensis, the agent of a deep fungal infection highly endemic in Central and South America, has been associated with two types of CNS lesions: granuloma reaction in the meninges, frequently causing a ba silar leptomeningitis similar to tuberculous meningitis; solitary and multiple gra nulomas, most commonly localized in cerebral hemispheres 11 .We report a patient with a large granuloma of South American blasto mycosis in the right fronto-parietal region, successfuly treated with sulfame thoxazole-trimethoprim alone, with follow-up documented by repeated CT scans. CASE REPORTA.M.S., a 59-year-old Brazilian male, truck drive, was admitted to the University of Campinas Hospital because of partial motor seizures starting in the left extremities and progressing to generalized tonic-clonic movements, beginning four months before, associated with a two months history of left progressive hemiparesis. He had been smoking a pack of cigarettes per day since age nine and had abused alcohol up to eight months before admission. Physical examination disclosed discretely pale mucous membranes, distant breath sounds and mild hepatomegaly. The neurologic examination showed a severe left hemiparesis predominating in the upper extremity, suggesting a supratentorial lesion; funduscopic examination and mental status were normal. CBC showed mild normocytic anemia and increased sedimentation rate.Skull X-ray, EEG and CSF were normal. A cranial CT (Fig 1 A) revealed a large hypodense area in the right fronto-parietal region extending up to the cortex; contrast iniection enhanced the central area and ring-like pattern. A chest X-ray showed bilateral diffuse pulmonary infiltrates, more proeminent in the parahilar regions, consistent with pulmonary paracoccidioidomycosis (Fig. 2). Sputum smears revealed the presence of Paracoccidioides brasiliensis. Treatment was started 1200 mg of sulfamethoxazole, plus 240 mg of trimethoprim twice a day. The seizures were controled with phenobarbital 100 mg per day. One week after initiation of treatment with sulfamethoxazole-trimethoprim a definite improvement of the left hemiparesis was noted. After the first month, clinical improvement was remarkable but the contrasted CT scan (Fig 1 B) still showed the lesion, although there was evidence

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Paracoccidioidal Granulomatosis of the Brain

Cited by 19 publications

References 9 publications

Holmes' tremor and neuroparacoccidioidomycosis: A case report

Holmes' tremor and neuroparacoccidioidomycosis: A case report

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

Novo tratamento para extenso granuloma paracoccidioidomicótico cerebral

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