Paracoccidioidomycosis In Cerebral Hemisphere And Brainstem: Case Report [paracoccidioidomicose Em Hemisfério Cerebral E Tronco Encefálico: Relato De Caso]

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadoliniumenhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines). © 2006 Associação Arquivos de Neuro-Psiquiatria.6403:00:00Colli, B.O., Assirati Jr., J.A., Machado, H.R., Intramedullary spinal cord paracoccidioidomycosis: Report of two cases (1996) Arq Neuropsiquiatr, 54, pp. 466-473Pacheco, R.A.B., Arruda, W.O., Hunhevicz, S.C., Tsubouchi, M.H., Torres, L.F.B., Thoracic intraspinal paracoccidioidomycosis: Case report (1996) Arq Neuropsiquiatr, 54, pp. 474-478Tristano, A.G., Chollet, M.E., Willson, M., Perez, J., Troccoli, M., Central nervous system paracoccidioidomycosis: Case report and review (2004) Invest Clin, 45, pp. 277-288Magalhaes, A.C., Caramelli, P., Silva, E.D., Magnetic resonance imaging in intracranial paracoccidioidomycosis (1993) J Neuroimaging, 3, pp. 216-219Almeida, S.M., Central nervous system paracoccidioidomycosis: An overview (2005) Braz J Infect Dis, 9, pp. 126-133Silva, C.E.A.P., Cordeiro, A.F., Gollner, A.M., Cupolilo, S.M.N., Quesado-Filgueiras, M., Curzio, M.F., Paracoccidioidomicose do sistema nervoso central: Relato de caso (2000) Arq Neuropsiquiatr, 58, pp. 741-747Moraes-Vasconcelos, D., Grumach, A.S., Yamaguti, A., Paracoccidioides brasiliensis disseminated disease in a patient with inherited deficiency in the beta 1 subunit of the interleukin (IL)-12/IL-23 receptor (2005) Clin Infect Dis, 41, pp. 31-37Del Brutto, O.H., Central nervous system mycotic infections (2000) Rev Neurol, 30, pp. 447-459Elias Jr., J., Dos Santos, A.C., Carlotti Jr., C.G., Central nervous system paracoccidioidomycosis: Diagnosis and treatment (2005) Surg Neurol, 63 (SUPPL.), pp. S13-S21Gonzales, A., Sahaza, J.H., Ortiz, B.L., Restrepo, A., Cano, L.E., Production of proinflammatoty cytokines during the early stages of experimental Paracoccidioides brasiliensis infection (2003) Med Mycol, 41, pp. 391-399Mamoni, R.L., Blotta, M.H., Kinetics of cytokines and chemokines gene expression distinguishes Paracoccidioides brasiliensis infection from disease (2005) Cytokine, 32, pp. 20-29Neworal, E.P., Altemani, A., Mamoni, R.L., Noronha, I.L., Blotta, M.H., Immunocytochemical localization of cytokines and inducible nitric oxide synthase (iNOS) in oral mucosa and lymph nodes of patients with paracoccidioidomycosis (2003) Cytokine, 21, pp. 234-241Peracoli, M.T., Kurokawa, C.S., Calvi, S.A., Production of pro- and anti-inflammatory cytokines by monocytes from patients with paracoccidioidomycosis (2003) Microbes Infect, 5, pp. 413-418Souto, J.T., Aliberti, J.C., Campanelli, A.P., Chemokine production and leukocyte recruitment to the lungs of Paracoccidioides brasiliensis-infected mice is modulated by interferon-gamma (2003) Am J Pathol, 163, pp. 583-590Pina, A., Valente-Ferreira, R.C., Molinari-Madlum, E.E., Vaz, C.A., Keller, A.C., Calich, V.L., Absence of interleukin-4 determines less severe pulmonary paracoccidioidomycosis associated with impaired Th2 response (2004) Infect Immun, 72, pp. 2369-2378Arruda, C., Valente-Ferreira, R.C., Pina, A., Dual role of interleukin-4 (IL-4) in pulmonary paracoccidioidomycosis: Endogenous IL-4 can induce protection or exacerbation of disease depending on the host genetic pattern (2004) Infect Immun, 72, pp. 3932-3940Romano, C.C., Mendes-Giannini, M.J., Duarte, A.J., Benard, G., The role of interleukin-10 in the differential expression of interleukin-12p70 and its beta 2 receptor on patients with active or treated paracoccidioidomycosis and healthy infected subjects (2005) Clin Immunol, 114, pp. 86-94Almeida, S.M., Queiroz-Telles, F., Teive, H.A., Ribeiro, C.E., Werneck, L.C., Central nervous system paracoccidioidomycosis: Clinical features and laboratorial findings (2004) J Infect, 48, pp. 193-198Duarte, A.L., Baruffa, G., Terra, H.B., Renck, D.V., Moura, D., Petrucci, C., Systemic paracoccidioidomycosis with central nervous system involvement (1999) Rev Soc Bras Med Trop, 32, pp. 439-442Fernandes, Y.B., Ramina, R., Borges, G., Queiroz, L.S., Maldaun, M.V.C., Maciel Jr., J.A., Orbital apex syndrome due to aspergillosis: Case report (2001) Arq Neuropsiquiatr, 59, pp. 806-80