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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682

Rev. Soc. Bras. Med. Trop. vol.43 no.6 Uberaba Nov./Dec. 2010

https://doi.org/10.1590/S0037-86822010000600037 

IMAGES IN INFECTIOUS DISEASES

 

 

Concomitant progressive multifocal leukoencephalopathy and disseminated paracoccidiodomycosis in an AIDS patient

 

 

José Roberto LambertucciI; Thiago Cardoso ValeII; Izabela VoietaI

IInfectious Diseases Branch, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
IINeurology Unit, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG

Address to

 

 

A 39-year-old man with a previous diagnosis of acquired immunodeficiency syndrome (AIDS) was admitted to hospital with a 2-week history of fever, weight loss, headache, diplopia and confusion. His previous CD4+ count had been 9 cells/mm3. Physical examination revealed painful and enlarged cervical, axillary and inguinal lymph nodes and ptosis of the left eyelid. Magnetic resonance (MR) showed a tumoral lesion in the cavernous sinus with a left internal carotid artery displacement (Figure A). MR also revealed another bilateral cerebral lesion suggestive of progressive multifocal leukoencephalopathy surrounding the lateral ventricles (Figure B). A cervical lymph node biopsy showed numerous leveduriform structures of Paracoccidioides brasiliensis (Figure C). He was treated with conventional amphotericin B for 36 days followed by itraconazole for 21 days and showed a slow, progressive recovery. Just before release from hospital, he was started on HAART (tenofovir, lamivudine, efavirenz). Four months later, at the outpatient clinic, he was asymptomatic.

 

REFERENCES

1. Lambertucci JR, Lana-Peixoto MA, Pitella JE. Paracoccidioidomycosis of the central nervous system. Rev Soc Bras Med Trop 2001; 34:395-396.         [ Links ]

2. Lambertucci JR, Rayes AA, Nunes F, Landazuri-Palacios JE, Nobre V. Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases. Rev Inst Med Trop Sao Paulo 1999; 41:27-32.         [ Links ]

3. Lima MA, Silva-Vergara ML, Demachki S, Santos JA. Paracoccidioidomycosis in a patient with human immunodeficiency virus infection. A necropsy case. Rev Soc Bras Med Trop 1995; 28:279-284.         [ Links ]

 

 

Address to:
Dr. José Roberto Lambertucci
Deptº de Clínica Médica/FM/UFMG
Av. Alfredo Balena 190
30130-100 Belo Horizonte, MG, Brazil
Phone: 55 31 3337-7781
e-mail: lamber@uai.com.br

Received in 31/10/2010
Accepted in 05/11/2010

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