Document Detail


Intramedullary spinal cord paracoccidioidomycosis. Report of two cases.
MedLine Citation:
PMID:  9109993     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion). The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developer paresthesia and tactile/pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion). The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma). The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.
Authors:
B O Colli; J A Assirati Júnior; H R Machado; J F Figueiredo; L Chimelli; C P Salvarani; F Dos Santos
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Arquivos de neuro-psiquiatria     Volume:  54     ISSN:  0004-282X     ISO Abbreviation:  Arq Neuropsiquiatr     Publication Date:  1996 Sep 
Date Detail:
Created Date:  1997-06-05     Completed Date:  1997-06-05     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0125444     Medline TA:  Arq Neuropsiquiatr     Country:  BRAZIL    
Other Details:
Languages:  eng     Pagination:  466-73     Citation Subset:  IM    
Affiliation:
Department of Surgery, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Granuloma / pathology,  radiography*,  surgery
Humans
Lung / radiography
Male
Middle Aged
Myelography
Paracoccidioidomycosis / pathology,  radiography*,  surgery
Photomicrography
Spinal Cord Diseases / microbiology,  radiography*,  surgery
Tomography, X-Ray Computed

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