Paracoccidioidomycosis – central nervous system and spinal cord involvement: report case
DOI:
https://doi.org/10.11606/issn.2317-0190.v16i1a103044Keywords:
Paracoccidioidomycosis, Paraplegia, Mycoses, RehabilitationAbstract
The paracoccidioidomycosis (PCM) is a systemic granulomatous mycosis, with Brazil being responsible for 80% of the cases reported in the world. Even in endemic zones its incidence is low (3-4 new cases/million up to 1-3 new cases/100 thousand inhabitants per year). We will report the case of a 54 year old woman, from the rural area in the North region of the state of Goiás, Central area of Brazil. During investigation for the medullar compressive syndro-me, a tumor lesion at the thoracic level was identified, submitted to resection, and diagnostically confirmed as neuroparacoccidioi-domycosis in the anatomical pathology analysis. She was admitted for rehabilitation with the diagnosis of T9 Asia B Paraplegia. During her stay, exams were performed (computerized tomography (CT) of the brain and thorax) to investigate the state of other organs. A thorax CT showed an aspect suggesting PCM with micronodules with center-lobular location and some opaqueness in “tree-in-bud” formation with moderate distortion of the pulmonary architecture, in addition to spots of attenuation in “opaque glass” appearance with non-homogeneous distribution. A cranial CT also suggested PCM in an active phase: nodular areas in nuclear-capsule to the left and corresponding thalamus, with reactional edema and important peripheral emphasis. This disease is a public health problem in Brazil due to is incapacitating potential. It is difficult to diagnose, especially when it attacks the CNS, since this is an uncommon manifestation (pulmonary symptoms are most commonly found).
Downloads
References
Colli BO, Assirati Júnior JA, Machado HR, Figueiredo JF, Chimelli L, Salvarani CP, Santos F.Intramedullary spinal cord paracoccidioidomycosis. Report of two cases. Arq Neuropsiquiatr. 1996;54(3):466-73.
Moura LP, Raffin CN, Del Negro GM, Ferreira MS. Paracoccidioidomycosis evidencing spinal cord involvement treated with success by fluconazole. Arq Neuropsiquiatr. 1994;52(1):82-6.
Veronesi R, Focaccia R. Veronesi: tratado de infectologia. 9 ed. Sao Paulo: Atheneu; 1997.
Leal Filho MB, Borges G, Silva Junior RG, Aguiar AAX, Almeida BR, Silva Vieira MAC, Pinheiro LMR. Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report. Arq Neuropsiquiatr. 2006;64(3A):686-9.
Shikanai-Yasuda MA,Telles Filho FQ, Mendes RP, Colombo AL, Moretti ML. Consenso em paracoccidioidomicose. Rev Soc Bras Med Trop. 2006;39(3):297-310.
Fernandes YB, Ramina R, Borges G, Queiroz LS, Maldaun MV, Maciel Junior JA. Orbital apex syndrome due to aspergillosis: case report. Arq Neuropsiquiatr. 2001;59(3-B):806-8.
Silva CE, Cordeiro AF, Gollner AM, Cupolilo SM, Quesado-Filgueiras M, Curzio MF. Paracoccidioidomycosis of the central nervous system: case report. Arq Neuropsiquiatr. 2000;58(3A):741-7.
Magalhaes ACA, Bacheschi LA, Caramelli P. Paracoccidioidomicose do sistema nervoso central:estudo de cinco casos por ressonância nuclear magnética. Rev Hosp Clin Fac Med S Paulo. 1993;48:94-7.
Nóbrega JPS, Mattosinho-França LC, Spina-França A. Neuroparacoccidioidomicose. In: Del Negro G, Lacaz CS, Fiorillo AM. Paracoccidioidomicose: blastomicose sul-americana. Sao Paulo: Sarvier; 1982. p. 221-7.
American Spinal Injury Association [homepage on the Internet].Atlanta: American Spinal Injury Association; c1996.[cited 2008 Abr 03]. Available from: http://www.asia-spinalinjury.org/publications/2006_Classif_worksheet.
Plá MP, Hartung C, Mendoza P, Stukanoff A, Moreno MJ. Neuroparacoccidioidomycosis: case reports and review. Mycopathologia. 1994;127(3):139-44.
Almeida SM, Queiroz-Telles F, Teive HA, Ribeiro CE, Werneck LC. Central nervous system paracoccidioidomycosis: clinical features and laboratorial findings. J Infect. 2004;48(2):193-8.
Argollo A, Reis VL, Niemeyer P, Vuono E. Central nervous system involvement in South American blastomycosis. Trans R Soc Trop Med Hyg. 1978;72(1):37-9.
Valle AC, Skacel M, Costa RL, Ribeiro CT, Montagna NA, Cruz LC.A case report of intraspinal paracoccidioidomycosis. Rev Inst Med Trop Sao Paulo. 1998;40(3):203-7.
Rodacki MA, De Toni G, Borba LA, Oliveira GG. Paracoccidioidomycosis of the central nervous system: CT findings. Neuroradiology. 1995;37(8):636-41.
Morato-Fernandez RN, Beraldo PSS, Masini M, Costa PHC. Paracoccidioidomicose de localizaçao intramedular e cerebral. Arq Neuropsiquiatr. 1991;49(2):192-7.
Pereira JM, Jacobs F. Um caso de blastomicose cutânea com acessos epilépticos. An Paul Med Cirurg. 1919;10:217-9.
Fagundes-Pereyra WJ, Carvalho GTC, Góes AM, Silva FCL, Sousa AA. Paracoccidimicosse do sistema nervoso central:análise de 13 casos. Arq Neuropsiquiatr. 2006;64(2-A):269-76.
Salaki JS, Louria DB, Chmel H. Fungal and yeast infections of the central nervous system. a clinical review. Medicine (Baltimore). 1984;63(2):108-32.
Dantas AM, Yamane R, Camara AG. South American blastomycosis: ophthalmic and oculomotor nerve lesions. Am J Trop Med Hyg. 1990;43(4):386-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2009 Acta Fisiátrica
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
