Central nervous system paracoccidioidomycosis: diagnosis and treatment.
BACKGROUND
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral.


METHODS
Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2).


RESULTS
Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up.


CONCLUSIONS
The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.
Elias
Jorge
J
Division of Imaging, Department of Internal Medicine, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, 14048-900 Ribeirão Preto, SP, Brazil.
dos Santos
Antonio Carlos
AC
Carlotti
Carlos Gilberto
CG
Colli
Benedicto Oscar
BO
Canheu
Alexandre
A
Matias
Caio
C
Furlanetti
Luciano
L
Martinez
Roberto
R
Takayanagui
Osvaldo Massaiti
OM
Sakamoto
Américo Ceiki
AC
Serafini
Luciano Neder
LN
Chimelli
Leila
L
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016921:Meningitis, Fungal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D010229:Paracoccidioidomycosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data
D000935:Antifungal Agents