Concomitant progressive multifocal leukoencephalopathy and disseminated paracoccidiodomycosis in an AIDS patient

Lambertucci, José Roberto; Vale, Thiago Cardoso; Voieta, Izabela

doi:10.1590/S0037-86822010000600037

IMAGES IN INFECTIOUS DISEASES

^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.

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