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Paracoccidioidomycosis simulating brain tumor.

Gustavo R Isolan1, Daniel M Vieira2, Francine Hehn3

  • 1Department of Neurology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90035-903, Porto Alegre, RS, Brazil ; Graduate Program in Medicine: Surgical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 90035-003, Porto Alegre, RS, Brazil.

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|October 10, 2014
PubMed
Summary
This summary is machine-generated.

Central nervous system (CNS) paracoccidioidomycosis (PCM) can mimic brain tumors on MRI. Prompt diagnosis in endemic areas is crucial for effective treatment with antifungals like amphotericin B.

Keywords:
Brain neoplasmscentral nervous systemmagnetic resonance imagingparacoccidioidomycosis

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Paracoccidioidomycosis (PCM), caused by Paracoccidioides brasiliensis, is a systemic granulomatous disease.
  • Central nervous system (CNS) involvement occurs in approximately 10% of PCM cases, presenting diagnostic challenges.

Observation:

  • A 57-year-old male presented with headache and focal seizure, with MRI revealing a ring-enhancing lesion in the parietal lobe, mimicking a neoplasm.
  • Surgical resection yielded pathognomonic findings of PCM: large, thick-walled yeast cells with multiple buds.
  • Cerebrospinal fluid analysis ruled out encephalitis and meningitis; HIV testing was negative.

Findings:

  • Magnetic resonance imaging (MRI) findings of CNS PCM, including ring enhancement and vasogenic edema, can be mistaken for primary brain tumors.
  • Anatomopathological examination confirmed Paracoccidioides brasiliensis yeast cells, establishing the diagnosis.
  • Treatment with amphotericin B resulted in clinical improvement and resolution of symptoms, despite residual visual field deficits.

Implications:

  • Radiographic features of CNS PCM can obscure the diagnosis, necessitating a high index of suspicion in endemic regions.
  • Early consideration of PCM is vital when MRI reveals ring-enhancing lesions with surrounding edema, especially in areas where the fungus is prevalent.
  • Timely diagnosis and treatment of CNS paracoccidioidomycosis are essential for favorable patient outcomes.