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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.11 São Paulo Nov. 2014 

Images in Neurology

Paracoccidioidomycosis: a rare cause of infectious encephalomyelopathy

Paracoccidioidomicose: uma causa rara de encefalomielopatia infecciosa

Paulo Victor Sgobbi de Souza1 

Wladimir Bocca Vieira de Rezende Pinto2 

Sandro Luiz de Andrade Matas2 

1Universidade Federal de São Paulo, Sao Paulo SP, Brazil

2Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Sao Paulo SP, Brazil

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.


. 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. [ Links ]

. Almeida SM. Central nervous system paracoccidioidomycosis: an overview. Braz J Infect Dis. 2005;9(2):126-33. [ Links ]

Received: August 05, 2014; Revised: August 17, 2014; Accepted: September 05, 2014

Correspondence: Wladimir Bocca Vieira de Rezende Pinto; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo; Rua Pedro de Toledo, 650; 04023-900 São Paulo SP, Brazil; E-mail:

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.