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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.
AuthorsMario León Silva-Vergara, Ivonete Helena Rocha, Rakel Rocha Vasconcelos, André Luiz Maltos, Fernando de Freitas Neves, Luciana de Almeida Silva Teixeira, Delio José Mora
JournalMycopathologia (Mycopathologia) Vol. 177 Issue 1-2 Pg. 137-41 (Feb 2014) ISSN: 1573-0832 [Electronic] Netherlands
PMID24464241 (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

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