PMID- 10968887
OWN - NLM
STAT- MEDLINE
DCOM- 20001116
LR  - 20190607
IS  - 0036-4665 (Print)
IS  - 0036-4665 (Linking)
VI  - 42
IP  - 4
DP  - 2000 Jul-Aug
TI  - Central nervous system paracoccidioidomycosis. Report of a case successfully 
      treated with itraconazol.
PG  - 231-4
AB  - Paracoccidioidomycosis (PCM) is a primary pulmonary infection that often 
      disseminates to other organs and systems. Involvement of the central nervous 
      system (CNS) is rare and due to the fact that both clinical alertness and 
      establishment of the diagnosis are delayed, the disease progresses causing 
      serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM), 
      observed in a 55 year-old male, who consulted due to neurological symptoms (left 
      hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic 
      clonic seizures) of a month duration. Upon physical examination, an ulcerated 
      granulomatous lesion was observed in the abdomen. To confirm the diagnosis a 
      stereotactic biopsy was taken; additionally, mycological tests from the ulcerated 
      lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. 
      brasiliensis yeast cells were visualized and later on, the brain biopsy revealed 
      the presence of the fungus. Treatment with itraconazole (ITZ) was initiated but 
      clinical improvement was unremarkable; due to the fact that the patient was 
      taking sodium valproate for seizure control, drug interactions were suspected and 
      confirmed by absence of ITZ plasma levels. The latter medication was changed to 
      clonazepam and after several weeks, clinical improvement began to be noticed and 
      was accompanied by diminishing P. brasiliensis antigen and antibody titers. In 
      the PCM endemic areas, CNS involvement should be considered more often and the 
      efficacy of itraconazole therapy should also be taken into consideration.
FAU - Villa, L A
AU  - Villa LA
AD  - Departamento de Neurologia, Facultad de Medicina, Hospital Universitario San 
      Vicente, Universidad de Antioquia, Colombia.
FAU - Tobon, A
AU  - Tobon A
FAU - Restrepo, A
AU  - Restrepo A
FAU - Calle, D
AU  - Calle D
FAU - Rosero, D S
AU  - Rosero DS
FAU - Gomez, B L
AU  - Gomez BL
FAU - Restrepo, A
AU  - Restrepo A
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Brazil
TA  - Rev Inst Med Trop Sao Paulo
JT  - Revista do Instituto de Medicina Tropical de Sao Paulo
JID - 7507484
RN  - 0 (Anticonvulsants)
RN  - 0 (Antifungal Agents)
RN  - 304NUG5GF4 (Itraconazole)
RN  - 5PE9FDE8GB (Clonazepam)
RN  - 614OI1Z5WI (Valproic Acid)
SB  - IM
MH  - Anticonvulsants/therapeutic use
MH  - Antifungal Agents/blood/*therapeutic use
MH  - Brain Diseases/diagnosis/*drug therapy
MH  - Clonazepam/therapeutic use
MH  - Drug Interactions
MH  - Humans
MH  - Itraconazole/blood/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Paracoccidioidomycosis/diagnosis/*drug therapy
MH  - Seizures/drug therapy
MH  - Treatment Outcome
MH  - Valproic Acid/therapeutic use
EDAT- 2000/09/01 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/01 11:00
PHST- 2000/09/01 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/01 11:00 [entrez]
AID - S0036-46652000000400009 [pii]
AID - 10.1590/s0036-46652000000400009 [doi]
PST - ppublish
SO  - Rev Inst Med Trop Sao Paulo. 2000 Jul-Aug;42(4):231-4. doi: 
      10.1590/s0036-46652000000400009.