Elias Jorge, dos Santos Antonio Carlos, Carlotti Carlos Gilberto, Colli Benedicto Oscar, Canheu Alexandre, Matias Caio, Furlanetti Luciano, Martinez Roberto, Takayanagui Osvaldo Massaiti, Sakamoto Américo Ceiki, Serafini Luciano Neder, Chimelli Leila
Division of Imaging, Department of Internal Medicine, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, 14048-900 Ribeirão Preto, SP, Brazil.
Surg Neurol. 2005;63 Suppl 1:S13-21; discussion S21. doi: 10.1016/j.surneu.2004.09.019.
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral.
Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2).
Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up.
The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.
副球孢子菌病（PCM）是由巴西副球孢子菌引起的一种系统性真菌病。中枢神经系统（CNS）受累在副球孢子菌病中比之前认为的更为常见，并且已报道有两种临床表现形式，即脑膜炎型和假肿瘤型。
分析了1986年至2003年期间接受治疗的20例中枢神经系统副球孢子菌病患者的病历。随访时间为1至18年（平均 = 8.9 +/- 4.2）。
除中枢神经系统副球孢子菌病外，所有患者（仅1例除外）均患有慢性全身型，且假肿瘤型临床表现最为常见。根据计算机断层扫描结果，确定了4种影像模式：环形强化的低密度病变、伴有钙化和环形强化的病变、多房性环形强化低密度病变以及弥漫性蛛网膜下腔强化。对3例患者进行了磁共振成像检查，1例显示蛛网膜下腔强化，2例显示伴有环形强化的不均匀病变。11例患者接受了药物治疗，9例需要神经外科治疗；4例患者进行了脑室腹腔分流术，3例患者进行了脑病变切除术，2例患者进行了脊髓病变部分切除术。11例患者预后良好，4例患者死亡，3例患者临床状况良好但有残留肺功能障碍，1例患者失访。
诊断累及中枢神经系统的副球孢子菌病较为困难，临床怀疑是做出正确诊断的关键。早期诊断的患者通过临床或手术治疗预后良好。
