Paracoccidioidomycosis: a rare cause of infectious encephalomyelopathy

Paracoccidioidomicose: uma causa rara de encefalomielopatia infecciosa

A 50-year-old man presented with a 2-year-history of gait imbalance and subacute paraparesis with sphincter dysfunction. Examination disclosed truncal ataxia and a complete spinal cord syndrome without sensory level. Neuroimaging showed a ring-enhancing lesion in the cerebellum (Figure 1) and an intramedullary lesion at T7 level (Figure 2). Cerebellar biopsy revealed Paracoccidioides brasiliensis infection.

Figure 1
(A) Brain MRI disclosing a hyperintense lesion in the superior vermis on axial T1-weighted images; (B) hypointense on axial T2; (C) FLAIR-weighted sequences; and (D) with ring-enhancing on sagittal post-gadolinium T1-weighted images.

Figure 2
(A) T2-weighted sagittal MRI of the spine revealing an intramedullary lesion at T7 level with nodular enhancement on (B) sagittal and (C) axial post-gadolinium T1-weighted sequences; (D) Chest CT scan disclosing bilateral peripherally located ground-glass opacities and peribronchovascular micronodules.

Paracoccidioidomycosis is a chronic granulomatous fungal disease caused by P. brasiliensis that compromises lung, mucosa, cutaneous tissue, adrenals and central nervous system (CNS)¹. CNS involvement of paracoccidioidomycosis should be considered in the differential diagnosis of chronic meningoencephalitis, encephalomyelopathy and in the expansive lesions of the CNS².

References

• ¹
  Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA, Felipe MSS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol. 2013;8(9):1177-91. http://dx.doi.org/10.2217/fmb.13.68
  » https://doi.org/10.2217/fmb.13.68
• ²
  Almeida SM. Central nervous system paracoccidioidomycosis: an overview. Braz J Infect Dis. 2005;9(2):126-33. http://dx.doi.org/10.1590/S1413-86702005000200002
  » https://doi.org/10.1590/S1413-86702005000200002

Publication Dates

• Publication in this collection
  Nov 2014

History

• Received
  05 Aug 2014
• Reviewed
  17 Aug 2014
• Accepted
  05 Sept 2014