“Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis

Abstract

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.

A new sign in paracoccidioidomycosis neuroimaging

“…The article “Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis , authored by Santana et al ( 11 ) and published in this issue of Radiologia Brasileira, despite being a retrospective analysis, makes a significant contribution by taking a different approach from other works, providing, for the first time, an analysis of the evolution of the imaging aspects of NPCM on post-treatment MRI of 56 brain lesions. In their study, the authors found that 84.4% of the lesions smaller than 1.2 cm disappeared during treatment, whereas the larger lesions tended to remain stable, in terms of size and peripheral enhancement, even after treatment.…”