Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report
Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with r...
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| Format: | Article |
| Language: | English |
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Thieme Revinter Publicações Ltda.
2021-06-01
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| Series: | Brazilian Neurosurgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1719005 |
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| author | Eduardo Cambruzzi Karla Lais Pêgas Gabriella Bezerra Cortês Nascimento José Nathan Andrade Muller da Silva Natália Brandelli Zandoná William Pegoraro Kus Felipe Lourezon Schiavo Samir Cezimbra dos Santos |
| author_facet | Eduardo Cambruzzi Karla Lais Pêgas Gabriella Bezerra Cortês Nascimento José Nathan Andrade Muller da Silva Natália Brandelli Zandoná William Pegoraro Kus Felipe Lourezon Schiavo Samir Cezimbra dos Santos |
| author_sort | Eduardo Cambruzzi |
| collection | DOAJ |
| description | Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CT scans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 × 3.2 × 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found. |
| first_indexed | 2024-12-16T10:19:00Z |
| format | Article |
| id | doaj.art-067777c9e47e4228b451d16655597a0f |
| institution | Directory Open Access Journal |
| issn | 0103-5355 2359-5922 |
| language | English |
| last_indexed | 2024-12-16T10:19:00Z |
| publishDate | 2021-06-01 |
| publisher | Thieme Revinter Publicações Ltda. |
| record_format | Article |
| series | Brazilian Neurosurgery |
| spelling | doaj.art-067777c9e47e4228b451d16655597a0f2022-12-21T22:35:21ZengThieme Revinter Publicações Ltda.Brazilian Neurosurgery0103-53552359-59222021-06-014002e195e19910.1055/s-0040-1719005Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case ReportEduardo Cambruzzi0Karla Lais Pêgas1Gabriella Bezerra Cortês Nascimento2José Nathan Andrade Muller da Silva3Natália Brandelli Zandoná4William Pegoraro Kus5Felipe Lourezon Schiavo6Samir Cezimbra dos Santos7Department of Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BrazilDepartment of Pathology, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, RS, BrazilGrupo Hospitalar Conceição, Porto Alegre, RS, BrazilGrupo Hospitalar Conceição, Porto Alegre, RS, BrazilGrupo Hospitalar Conceição, Porto Alegre, RS, BrazilGrupo Hospitalar Conceição, Porto Alegre, RS, BrazilDepartment of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, RS, BrazilDepartment of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, RS, BrazilNeuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CT scans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 × 3.2 × 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1719005paracoccidiodomycosissouth american blastomycosisparacoccidioides brasiliensiscentral nervous systemmycosispathology |
| spellingShingle | Eduardo Cambruzzi Karla Lais Pêgas Gabriella Bezerra Cortês Nascimento José Nathan Andrade Muller da Silva Natália Brandelli Zandoná William Pegoraro Kus Felipe Lourezon Schiavo Samir Cezimbra dos Santos Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report Brazilian Neurosurgery paracoccidiodomycosis south american blastomycosis paracoccidioides brasiliensis central nervous system mycosis pathology |
| title | Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report |
| title_full | Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report |
| title_fullStr | Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report |
| title_full_unstemmed | Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report |
| title_short | Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report |
| title_sort | multifocal pseudotumorous form of neuroparacoccidioidomycosis in an immunocompetent patient a clinicopathological review based on a case report |
| topic | paracoccidiodomycosis south american blastomycosis paracoccidioides brasiliensis central nervous system mycosis pathology |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1719005 |
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