Tristano Antonio G, Chollet María Eugenia, Willson María, Perez Julián, Troccoli Marcos
Department of Internal Medicine, Dr. Domingo Luciani Hospital, Caracas, Venezuela.
Invest Clin. 2004 Sep;45(3):277-88.
Paracoccidioidomycosis is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). The most common lesions frequently occur in the bucopharinx mucosa. Other lesions occur in the adrenal glands, liver, bone, gastrointestinal tract, lungs and nervous system. We report here a case of neuroparacoccidioidomycosis. The patient was a 49 year-old male, who consulted due to neurological symptoms (cephalalgia, speech difficulty and one tonic clonic seizure with urinary incontinence) of eight months duration. Upon physical examination it was observed an emaciated male with nail clubbing, a skin ulcer with raised edges and a crusted bottom of 4 x 2 cm in diameter located in the right supraclavicular region and an ulcerated lesion in the left tonsil with edema. The rest of the physical examination reveled a discrete left side hemiparesis and pulmonary rales in the left hemitorax. The fungus was identified through direct examination of cerebrospinal fluid (CSF). The histopathology of suprarenal, lungs, brain and skin showed multiple paracoccidioidal granulomas. To the best of our knowledge, this is the third case reported in the literature. We review the literature on the pathogenesis and prevalence of neuroparacoccidioidomycosis.
副球孢子菌病是一种由双相真菌（巴西副球孢子菌）引起的全身性感染。最常见的病变常发生在口腔咽部黏膜。其他病变发生在肾上腺、肝脏、骨骼、胃肠道、肺部和神经系统。我们在此报告一例神经副球孢子菌病病例。患者为一名49岁男性，因持续8个月的神经症状（头痛、言语困难和一次伴有尿失禁的强直阵挛性发作）前来就诊。体格检查发现一名消瘦男性，有杵状指，右侧锁骨上区域有一个直径4×2 cm、边缘隆起、底部结痂的皮肤溃疡，左侧扁桃体有一个溃疡病变并伴有水肿。体格检查的其他结果显示左侧轻度偏瘫和左半侧胸廓有肺部啰音。通过直接检查脑脊液（CSF）鉴定出真菌。肾上腺、肺、脑和皮肤的组织病理学显示多个副球孢子菌性肉芽肿。据我们所知，这是文献中报道的第三例病例。我们回顾了关于神经副球孢子菌病发病机制和患病率的文献。
