Paracoccidioidomycosis: a rare cause of infectious
encephalomyelopathyA 50-year-old man presented with a 2-year-history of gait imbalance and subacute paraparesis with sphincter dysfunction. Examination disclosed truncal ataxia and a complete spinal cord syndrome without sensory level. Neuroimaging showed a ring-enhancing lesion in the cerebellum (Figure 1) and an intramedullary lesion at T7 level (Figure 2). Cerebellar biopsy revealed Paracoccidioides brasiliensis infection.
(A) Brain MRI disclosing a hyperintense lesion in the superior vermis on axial T1-weighted images; (B) hypointense on axial T2; (C) FLAIR-weighted sequences; and (D) with ring-enhancing on sagittal post-gadolinium T1-weighted images.
(A) T2-weighted sagittal MRI of the spine revealing an intramedullary lesion at T7 level with nodular enhancement on (B) sagittal and (C) axial post-gadolinium T1-weighted sequences; (D) Chest CT scan disclosing bilateral peripherally located ground-glass opacities and peribronchovascular micronodules.
Paracoccidioidomycosis is a chronic granulomatous fungal disease caused by P. brasiliensis that compromises lung, mucosa, cutaneous tissue, adrenals and central nervous system (CNS)1. CNS involvement of paracoccidioidomycosis should be considered in the differential diagnosis of chronic meningoencephalitis, encephalomyelopathy and in the expansive lesions of the CNS2.
References
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1 Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA,
Felipe MSS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and
therapeutic issues. Future Microbiol. 2013;8(9):1177-91.
http://dx.doi.org/10.2217/fmb.13.68
» https://doi.org/10.2217/fmb.13.68 -
2 Almeida SM. Central nervous system paracoccidioidomycosis: an
overview. Braz J Infect Dis. 2005;9(2):126-33.
http://dx.doi.org/10.1590/S1413-86702005000200002
» https://doi.org/10.1590/S1413-86702005000200002
