Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil Feohifomicose cerebral ("cromoblastomicose") por Fonsecaea pedrosoi: primeiro caso demonstrado por cultura do fungo no Brasil

Cerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded. The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found.<br>A Feohifomicose cerebral ("cromoblastomicose") é uma lesão rara. Apresentamos o primeiro caso desta entidade com cultura do abscesso cerebral, devido a Fonsecaea pedrosoi. O paciente, um homem de 28 anos de idade, imunocompetente, apresentou manifestações oculares e síndrome de hipertensão intracraniana. Imagens de ressonância magnética (MRI) cerebral mostraram massa tumoral envolvendo a área temporo-occipital direita e outra lesão menor, possivelmente cicatricial, no lobo occipital esquerdo. Biopsia cerebral mostrou cromoblastomicose cerebral. A lesão principal foi enucleada cirurgicamente e Fonsecaea pedrosoi foi cultivado da massa necrótica e supurada. O paciente tinha tido um ferimento por faca 16 anos antes de ser visto no nosso hospital e, mais recentemente, uma lesão pulmonar granulomatosa no pulmão direito onde foi identificada uma forma isolada, não pigmentada, de fungo. A possibilidade de que o fungo tenha penetrado no organismo do paciente através da lesão de pele foi considerada, mas não se pode excluir uma eventual lesão primária pulmonar. O paciente teve alta hospitalar e foi seguido durante oito meses sem recorrência da doença. Meses depois, entretanto, desenvolveu complicações relacionadas à neurocirurgia, vindo a óbito. Uma autopsia completa foi feita, não demonstrando doença fúngica remanescente

Treatment of peripheral neuropathies.

There are three general approaches to treatment of peripheral neuropathy. First, an attempt should be made to reverse the pathophysiological process if its nature can be elucidated. Second, nerve metabolism can be stimulated and regeneration encouraged. Third, even if the neuropathy itself cannot be improved, symptomatic therapy can be employed. This review outlines the options available for each approach