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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(02): 134-139
DOI: 10.1055/s-0038-1641578
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Neuroparacoccidioidomycosis: Case Report and Literature Review

Neuroparacoccidioidomicose: relato de caso e revisão da literatura
Marcus Vinicius de Morais
1   Division of Neurosurgery, Hospital Militar de Área de São Paulo, São Paulo, SP, Brazil
,
Sérgio Murilo Georgeto
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
Marcelo Lourenço Haddad
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
José Guilherme da Silva Amorim
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
Luis Guilherme Scaliante
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
Anderson Luiz de Paula
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
Igor Vasconcelos de Andrade
2   Division of Neurosurgery, Santa Casa de Londrina Hospital, Londrina, PR, Brazil
,
Paulo Henrique Pires de Aguiar
3   Division of Neurology, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil
› Author Affiliations
Further Information

Publication History

29 January 2018

27 February 2018

Publication Date:
04 April 2018 (online)

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Abstract

Introduction Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis, and it can compromise the central nervous system (CNS) in 10–27% of all cases.

Case Report A 31-year-old man presented to the Emergency Department with headache, left-sided weakness, clonus at the ankle and a positive Babinski sign. Head computed tomography (CT) and magnetic resonance imaging (MRI) scans showed a 5.1 × 3.8 cm lobulated lesion with areas of liquefaction in the right centrum semiovale.

Discussion Central nervous system PCM can mimic a brain tumor, and most cases are diagnosed by biopsy of the lesion. The treatment includes antibiotics, but some cases require surgery.

Conclusion Due to high morbimortality rates, the diagnosis must be considered, and early treatment started in patients who live in rural regions endemic for PCM when a ring-enhancing mass associated with perilesional edema is observed on MRI scans.

Resumo

Introdução Paracoccidioidomicose (PCM) é uma micose sistêmica causada pelo fungo Paracoccidioides brasiliensis e que pode comprometer o sistema nervoso central (SNC) em 10–27% dos casos.

Relato de caso Um homem de 31 anos é admitido no pronto socorro com cefaleia, hemiparesia esquerda com clonus e presença de sinal de Babinski. As imagens da tomografia computadorizada (TC) de crânio e da ressonância nuclear magnética (RNM) demonstraram uma lesão de 5,1 × 3,8 cm no centro semioval direito de aspecto lobulado com áreas de liquefação no centro semioval direito.

Discussão Paracoccidioidomicose do SNC pode simular um tumor cerebral, sendo a maioria dos casos diagnosticada por biopsia da lesão. O tratamento inclui antibióticos, mas alguns casos necessitam de abordagem cirúrgica.

Conclusão Devido à alta morbimortalidade, o diagnóstico deve ser considerado e o tratamento precoce iniciado em pacientes que vivem em áreas rurais endêmicas para PCM e que apresentam lesão com captação anelar de contraste associada a edema perilesional nas imagens de RNM.

Keywords

paracoccidioidomycosis - central nervous system

Palavras-chave

paracoccidioidomycosis - sistema nervoso central
 

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