Central nervous system paracoccidioidomycosis in an AIDS patient: case report.

Abstract

Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.

• Authors: Mario León Silva-Vergara, Ivonete Helena Rocha, Rakel Rocha Vasconcelos, André Luiz Maltos, Fernando de Freitas Neves, Luciana de Almeida Silva Teixeira, Delio José Mora
• Journal: Mycopathologia (Mycopathologia) Vol. 177 Issue 1-2 Pg. 137-41 (Feb 2014) ISSN: 1573-0832 [Electronic] Netherlands
• PMID: 24464241 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Itraconazole
• Amphotericin B

Topics

• Acquired Immunodeficiency Syndrome (etiology)
• Adult
• Amphotericin B (therapeutic use)
• Antifungal Agents (therapeutic use)
• Brazil
• CD4-Positive T-Lymphocytes (immunology)
• Central Nervous System Fungal Infections (drug therapy, microbiology)
• Humans
• Itraconazole (therapeutic use)
• Lymphocyte Count
• Male
• Meningoencephalitis (diagnosis, microbiology)
• Paracoccidioides (pathogenicity)
• Paracoccidioidomycosis (complications, drug therapy, microbiology)
• Tomography, X-Ray Computed
• Viral Load