M Rosa Júnior1, A C Amorim2, I V Baldon2, L A Martins2, R M Pereira2, R P Campos3, S S Gonçalves4, T R G Velloso5, P Peçanha6, A Falqueto6. 1. From the Departments of Neuroradiology (M.R.J.). 2. Radiology (A.C.A., I.V.B., L.A.M., R.M.P.), Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo, HUCAM/UFES/EBSERH, Vitória, Espírito Santo, Brazil. 3. Department of Neuroradiology (R.P.C.), Hospital Meridional, Cariacica, Espírito Santo, Brazil. 4. Departments of Pathology (S.S.G.). 5. Clinical Dentistry (T.R.G.V.). 6. Infectious Disease (P.P., A.F.), Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
Abstract
BACKGROUND AND PURPOSE: Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS: We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS: Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with >2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of >2 cm. CONCLUSIONS: The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.
BACKGROUND AND PURPOSE:Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS: We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS:Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with >2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of >2 cm. CONCLUSIONS: The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.
Authors: Priscila Marques de Macedo; Eduardo Mastrangelo Marinho Falcão; Dayvison Francis Saraiva Freitas; Andréa d'Avila Freitas; Ziadir Francisco Coutinho; Mauro de Medeiros Muniz; Rosely Maria Zancopé-Oliveira; Rodrigo Almeida-Paes; Marcus Tulius Teixeira da Silva; Antonio Carlos Francesconi do Valle Journal: J Fungi (Basel) Date: 2020-11-20