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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.37 no.3 São Paulo Sept. 1979

http://dx.doi.org/10.1590/S0004-282X1979000300009 

Cromomicose cerebral: registro de um caso

 

Cerebral cromomycosis: a case report

 

 

Luciano de Souza QueirozI; Anamarli NucciII; Flávio B. Lopes de FariaIII; Rogério de Jesus PedroIV; Nubor O. FacureV

IProfessor Assistente. Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Anatomia Patológica (Chefe - Prof. J. Lopes de Faria)
IIProfessor Assistente. Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Neurologia Clínica e Cirúrgica
IIIResidente. Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Anatomia Patológica (Chefe - Prof. J. Lopes de Faria)
IVProf. Assistente. Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Disciplina de Moléstias Transmissíveis do Departamento de Clínica Médica
VCoordenador do Departamento. Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Neurologia Clínica e Cirúrgica

 

 


RESUMO

As lesões cerebrais por fungos pigmentados são excepcionais. Os autores apresentam um caso de cromomicose do sistema nervoso central, em paciente de 59 anos. O quadro clínico iniciou-se por cefaléias e hemiparesia esquerda, seguida por meningite e síndrome de hipertensão intracraniana, totalizando uma evolução de nove meses. A neerópsia revelou abcesso encapsulado nos núcleos basais à direita e leptomeningite crônica de predomínio na base do encéfalo. Em ambas as localizações foram demonstrados numerosos fungos de cor castanha, em forma arredondada ou em hifas septadas. Discutem-se as dificuldades diagnosticas desta neuromicose.


SUMMARY

A case of brain abscess and meningitis due to pigmented fungi is reported. The patient was a 59-year-old white male, who had enjoyed excellent health until October 1977, when he developed headache, later accompanied by paresthesias and weakness in the left-sided extremities. These symptoms worsened progressively and in November of that year he had to quit his job. From February 1978 on he became inactive and anorexic. Intense continuous headache was associated with frequent episodes of vomiting. He gradually became tor-porous, and according to his relatives, suffered from visual and possibly auditory deficiency. On examination, he was malnourished and dehydrated, with decubitus ulcers. Temperature was 38,5°C. A left-sided spastic hemiplegia and prominent meningorradicular signs were noted. The CSF was examined six times between May 17th and June 1st and showed variable hypercytosis (143 to 4,437 leucocytes/ cu mm) with predominance of neutrophils (up tp 95%), low glucose and high protein concentrations. No microorganisms were identified. Electroencephalographic study disclosed a low background activity especially in left temporal areas. Despite supportive care and antibiotic therapy he lapsed into coma. Carotid angiography was normal on June 1st. He remained in deep coma until his death on June 6th, 1978.
Necropsy was limited to the brain, which weighed 1,550 g after fixation and showed diffuse intense edema and hyperemia. On coronal sectioning an encapsulated abscess was found in the right basal ganglia, which also involved the internal capsule, and measured 1.5 cm in diameter. Microscopical examination disclosed large numbers of brownish fungi, appearing both as oval yeasts and as septate hyphae in the thick fibrous capsule and in the necrotic content of the abscess. The same organisms were demonstrated in moderate numbers in the leptomeninges of the medulla oblongata and , less frequently, of the hippo-campal region and cerebellum.


 

 

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REFERENCIAS

1. BROWN, J. W.; NADELL, J.; SATJDERS, C. V. & SARDEGA, L. - Brain abcess caused by Cladosporium trichoides (Bantianum): a case with paranasal sinus invol-ment. South. Med. J. (Birmigham) 69:1519, 1976.         [ Links ]

2. CARRION, A. L. - Chromoblastomycosis and related infections: new concepts, differential diagnosis and nomenclatorial implications. Int. J. Dermatol. (Philadelphia) 14:27, 1975.         [ Links ]

3. COLLOMB, H.; DUMAS, M.; GIRARD, P. L. & N'DIAYE, I. P. - Dématiomy-cose cérébrale (Cladosporiose cérébrale). TJn cas chez un noir sénégalais. Sem. Hop. Paris 49:2857, 1973.         [ Links ]

4. DUQUE, O. - Cladosporiosis of the Central Nervous Tissue. In Handbuch der Spesdellen Pathologischen Anatomie und Histologie IP/5, Springer-Verlag, Berlin, pp. 7Ό0-718, 1971.         [ Links ]

5. FETTER, B. F.; KLINTWORTH, G. K. & HENDRY, W. S. - Mycoses of the Central Nervous System. Williams & Wilkins, Baltimore, pp. 63-73, 1967.         [ Links ]

6. LACAZ, C. da S. - Micologia Médica. Sarvier, São Paulo, pp. 295-310, 1973.         [ Links ]

7. QUEIROZ, L. S.; NUCCI, A. & FARIA, J. L. - Candidíase sistêmica com localização encefálica: estudo anátomo-clínico de cinco casos. Arq. Neuro-Psiquiat. (São Paulo) 34:18, 1976.         [ Links ]

8. SPINA-FRANÇA, A.; BRITTO, T. & ALMEIDA, F. P. - Cromomicose do sistema nervoso: estudo anátomo-clínico de um caso. Arq. Neuro-Psiquiat. (São Paulo) 11:265, 1953.         [ Links ]

9. SYMMERS, W. St. C. - A case of cerebral chromoblastomycosis (Cladosporiosis) occurring in Britain as a complication of polyarteritis treated with cortisone. Brain 83:37, 1960.         [ Links ]

10. VOLLUM, D. I. - Chromomycosis: a review. Br. J. Dermatol. (London) 96:454. 1977.         [ Links ]

 

 

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