SciELO - Scientific Electronic Library Online

 
vol.51 issue5A human immunodeficiency virus-positive woman with toxic epidermal necrolysis treated with human intravenous immunoglobulinYellow fever vaccination and neurological complications author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682On-line version ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.51 no.5 Uberaba Sept./Oct. 2018

http://dx.doi.org/10.1590/0037-8682-0379-2017 

Images in Infectious Diseases

Central nervous system histoplasmosis mimicking tentorium meningioma

Bruno Niemeyer de Freitas Ribeiro1 

Diogo Goulart Corrêa2 

Edson Marchiori3 

1Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brasil.

2Departamento de Radiologia, Hospital Casa de Portugal, Rio de Janeiro, RJ, Brasil.

3Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.


A 37-year-old immunocompetent female resident of Rio de Janeiro, Brazil, presented with a 2-month history of headache, without fever or any other symptoms. Results of serology for HIV and a venereal disease research laboratory test were both negative. Analyses of cerebrospinal fluid yielded normal findings. Brain magnetic resonance imaging (MRI) revealed a mass on the tentorium showing iso/hypointensity on T1- and T2-weighted images (Figure A and Figure B, respectively) with exuberant contrast enhancement (Figure C). Meningioma located in the tentorium was the main diagnosis. After surgical treatment, a histopathological diagnosis of histoplasmosis was made. Central nervous system (CNS) histoplasmosis commonly occurs in immunocompromised patients with disseminated infection1,2. The most common manifestation of CNS involvement is subacute or chronic meningitis1,2. Histoplasmosis mimicking a meningioma is exceptional and, in some cases, presents with the dural tail sign. This sign is seen on MRI as thickening of the dura mater, enhanced by venous contrast, which resembles a tail extending from a mass, and is generally related to meningiomas, which are the most common tumors of the meninges. In conclusion, histoplasmosis should be included in the differential diagnosis of CNS masses.

FIGURE Magnetic resonance imaging revealed a mass on the tentorium (arrows) caused by histoplasmosis that shows iso/hypointensity on T1- and T2-weighted images (A and B, respectively) with exuberant contrast enhancement on a gadolinium-enhanced, T1-weighted image (C). 

Acknowledgments

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

1. Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE, et al. Histoplasmosis with deep CNS involvement: case presentation with discussion and literature review. J Neurol Surg Rep. 2015;76(1):e167-72. [ Links ]

2. Azizirad O, Clifford DB, Groger RK, Prelutsky D, Schmidt RE. Histoplasmoma: isolated central nervous system infection with Histoplasma capsulatum in a patient with AIDS Case report and brief review of the literature. Clin Neurol Neurosurg. 2007;109(2):176-81. [ Links ]

Received: September 29, 2017; Accepted: April 05, 2018

Corresponding author: Dr. Bruno Niemeyer de Freitas Ribeiro. e-mail: bruno.niemeyer@hotmail.com

Conflict of interest: The authors declare that there is no conflict of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License