Zanotti Juliana S, Rodrigues Fernanda P, Daoud Alex Michel, Araujo João Luiz Vitorino, de Oliveira Jean Gonçalves
Neurological Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, BRA.
Cureus. 2025 Jun 21;17(6):e86503. doi: 10.7759/cureus.86503. eCollection 2025 Jun.
Central nervous system (CNS) histoplasmosis is a rare manifestation of Histoplasma capsulatum infection and is typically associated with disseminated disease in immunocompromised individuals. However, isolated CNS involvement in immunocompetent patients remains uncommon and poses a diagnostic challenge due to its nonspecific clinical presentation. We report the case of a 44-year-old immunocompetent male patient with a history of intravenous drug use who presented with seizures and progressive headache. Brain imaging revealed a left frontal ring-enhancing lesion with midline shift and surrounding edema. Despite negative systemic workup and serologies, the patient underwent surgical drainage of the abscess, and histopathological analysis confirmed infection by H. capsulatum. He was treated with liposomal amphotericin B for 50 days, resulting in full clinical recovery without neurological deficits. This case highlights the importance of including histoplasmosis in the differential diagnosis of cerebral abscesses, even in immunocompetent individuals from endemic areas, especially when noninvasive diagnostics are inconclusive. Early surgical intervention combined with appropriate antifungal therapy can lead to excellent outcomes.
中枢神经系统组织胞浆菌病是荚膜组织胞浆菌感染的一种罕见表现，通常与免疫功能低下个体的播散性疾病相关。然而，免疫功能正常的患者孤立性中枢神经系统受累仍然不常见，因其临床表现不具有特异性，故在诊断上具有挑战性。我们报告一例44岁有静脉吸毒史的免疫功能正常男性患者，该患者出现癫痫发作和进行性头痛。脑部影像学检查显示左额叶有环形强化病灶，伴有中线移位和周围水肿。尽管全身检查和血清学检查结果均为阴性，但该患者接受了脓肿手术引流，组织病理学分析证实为荚膜组织胞浆菌感染。他接受了50天的脂质体两性霉素B治疗，临床完全康复，无神经功能缺损。该病例强调了即使在来自流行地区的免疫功能正常个体中，尤其是在非侵入性诊断尚无定论时，将组织胞浆菌病纳入脑脓肿鉴别诊断的重要性。早期手术干预联合适当的抗真菌治疗可带来良好的治疗效果。
