Hippocampal sclerosis in paracoccidioidomycosis

Esclerose hipocampal na paracoccidioidomicose

A 39-year-old man presented with complex partial seizures five years after treatment of central nervous system (CNS) paracoccidioidomycosis (PCM). Post-treatment images showed reduction of the CNS lesions and appearance of hippocampal sclerosis (HS) (Figures 1 and 2). To the best of our knowledge, this is the first description between PCM and HS.

Figure 1.
(A) and (B) - T2WI and FLAIR show lesions with low T2WI signal (white arrows) with vasogenic edema. Note the normal hippocampi (red arrows). (C) - T1 post-contrast shows lesions with annular enhancement (white arrows). (D) - chest CT with cavitated lesions.

Figure 2.
(A) (FLAIR) and (B) (T1 post-contrast) - show lesion resolution and encephalomalacia after treatment (white arrows). (C) and (D) T2 and FLAIR - show volumetric reduction, signal hyperintensity and loss of internal architecture of the left hippocampus (red arrows) - HS.

HS is a common pathological finding in temporal lobe epilepsy¹. The etiology is controversial, whether acquired or developmental, however triggering factors of HS can be epilepticus status, febrile seizures, infectious and vascular diseases or malformations. When associated with other diseases, as in this case of PCM^2,3, it is called dual pathology.

References

• ¹
  Liu Z, Mikati M, Holmes GL. Mesial temporal sclerosis: pathogenesis and significance. Pediatr Neurol. 1995 Jan;12(1):5-16. https://doi.org/10.1016/0887-8994(94)00122-i
  » https://doi.org/https://doi.org/10.1016/0887-8994(94)00122-i
• ²
  Rosa Júnior M, Baldon IV, Amorim AC, Melo AFC, Peçanha P, Falqueto A, et al. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol. 2018 Jun;103:147-62. https://doi.org/10.1016/j.ejrad.2018.03.026
  » https://doi.org/https://doi.org/10.1016/j.ejrad.2018.03.026
• ³
  Rosa Júnior M, Amorim AC, Baldon IV, Martins RM, Pereira RP, Campos SS, et al. Paracoccidioidomycosis of the Central Nervous System: CT and MR imaging findings. AJNR Am J Neuroradiol. 2019 Oct;40(10):1681-8. https://doi.org/10.3174/ajnr.A6203
  » https://doi.org/https://doi.org/10.3174/ajnr.A6203

Publication Dates

• Publication in this collection
  29 May 2020
• Date of issue
  June 2020

History

• Reviewed
  28 Nov 2019
• Received
  08 Jan 2020
• Accepted
  27 Jan 2020