Riechelmann Ricardo Salemi, Rodrigues Leonardo Henrique, Avelar Tiago Marques, Xander Paulo Adolfo, da Costa Guilherme Henrique, Cannoni Luiz Fernando, de Aguiar Guilherme Brasileiro, Veiga Jose Carlos
Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil.
Surg Neurol Int. 2020 Jun 13;11:151. doi: 10.25259/SNI_224_2020. eCollection 2020.
Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery.
A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease.
PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.
副球孢子菌病（PCM）是一种由真菌引起的全身性、进行性、非传染性且通常为慢性的疾病，很少累及中枢神经系统（CNS）。该病通常采用抗真菌药物治疗，部分病例可能需要手术治疗。
一名55岁男性，有吸烟史，无已知合并症，因入院前一周有一次癫痫发作史，随后出现进行性右侧偏瘫，被转诊至神经外科团队。头部计算机断层扫描和脑磁共振成像显示，轴内有一个扩张性病变，累及左顶叶，伴有广泛水肿和局部压迫效应，导致轻度镰下疝，最初被当作脓肿处理。抗生素治疗失败后，患者接受了神经外科手术切除病变。组织病理学分析显示为PCM，且没有证据表明该疾病对其他系统造成损害。
PCM可能是一种严重的、使人衰弱的疾病，有潜在致命性。尽管孤立的中枢神经系统受累罕见，但必须予以考虑，尤其是在流行地区，因为晚期诊断和治疗会严重降低良好预后率。
