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.
(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.
(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)11 . 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...
. CNS
involvement of paracoccidioidomycosis should be considered in the differential diagnosis
of chronic meningoencephalitis, encephalomyelopathy and in the expansive lesions of the
CNS22 . 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/S1413-8670200500...
.
References
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1Bocca 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 -
2Almeida 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
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Publication in this collection
Nov 2014
History
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Received
05 Aug 2014 -
Reviewed
17 Aug 2014 -
Accepted
05 Sept 2014