Central nervous system paracoccidioidomycosis in an AIDS patient: case report.
Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.
Infectious Diseases Unit, Triângulo Mineiro Federal University, Avenida Frei Paulino, 30, Uberaba, Minas Gerais, CEP 38025-180, Brazil, marioleon.dip@mednet.com.br.
Mario León
ML
Silva-Vergara
Ivonete Helena
IH
Rocha
Rakel Rocha
RR
Vasconcelos
André Luiz
AL
Maltos
Fernando de Freitas
Fde F
Neves
Luciana de Almeida Silva
Lde A
Teixeira
Delio José
DJ
Mora
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D018655:Lymphocyte Count; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000382:microbiology*; D010228:Paracoccidioides / Q000472:pathogenicity*; D010229:Paracoccidioidomycosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D019562:Viral Load
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B