José Roberto LambertucciI; Thiago Cardoso ValeII; Izabela VoietaI
IInfectious Diseases Branch, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG IINeurology Unit, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
A 39-year-old man with a previous diagnosis of acquired immunodeficiency syndrome (AIDS) was admitted to hospital with a 2-week history of fever, weight loss, headache, diplopia and confusion. His previous CD4+ count had been 9 cells/mm3. Physical examination revealed painful and enlarged cervical, axillary and inguinal lymph nodes and ptosis of the left eyelid. Magnetic resonance (MR) showed a tumoral lesion in the cavernous sinus with a left internal carotid artery displacement (Figure A). MR also revealed another bilateral cerebral lesion suggestive of progressive multifocal leukoencephalopathy surrounding the lateral ventricles (Figure B). A cervical lymph node biopsy showed numerous leveduriform structures of Paracoccidioides brasiliensis (Figure C). He was treated with conventional amphotericin B for 36 days followed by itraconazole for 21 days and showed a slow, progressive recovery. Just before release from hospital, he was started on HAART (tenofovir, lamivudine, efavirenz). Four months later, at the outpatient clinic, he was asymptomatic.
REFERENCES
1. Lambertucci JR, Lana-Peixoto MA, Pitella JE. Paracoccidioidomycosis of the central nervous system. Rev Soc Bras Med Trop 2001; 34:395-396. [ Links ]
2. Lambertucci JR, Rayes AA, Nunes F, Landazuri-Palacios JE, Nobre V. Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases. Rev Inst Med Trop Sao Paulo 1999; 41:27-32. [ Links ]
3. Lima MA, Silva-Vergara ML, Demachki S, Santos JA. Paracoccidioidomycosis in a patient with human immunodeficiency virus infection. A necropsy case. Rev Soc Bras Med Trop 1995; 28:279-284. [ Links ]
Address to:
Dr. José Roberto Lambertucci
Deptº de Clínica Médica/FM/UFMG
Av. Alfredo Balena 190
30130-100 Belo Horizonte, MG, Brazil
Phone: 55 31 3337-7781
e-mail: lamber@uai.com.br
Received in 31/10/2010
Accepted in 05/11/2010
