Medular paracoccidioidomycosis: case report

Os autores relatam o caso de um homem de 55 anos, branco, tabagista, com paraparesia em membros inferiores, constipacao e retencao urinaria de inicio recente, com uma lesao ulcero-vegetante no palato mole, negativa para malignidade. Com o diagnostico de sindrome de compressao medular foram realizados exames, que evidenciaram liquor cefalorraquidiano normal, radiografia de torax com infiltrado pulmonar intersticio- -nodular bilateral, e ressonância magnetica de coluna lombosacra com pequenas lesoes com realce anelar na medula e edema adjacente, provavelmente relacionados a processo infeccioso. Um novo fragmento da lesao na mucosa foi positivo para paracoccidioidomicose, e o diagnostico provavel de lesao medular pelo Paracoccidioides brasiliensis foi realizado por convergencia de dados, como ocorre na maior parte dos raros casos em que essa doenca acomete a medula espinhal. Apos 6 meses, o paciente deambulava sem apoio, mantendo a necessidade de cateterizacao vesical intermitente, apos tratamento inicial com sulfametoxazol com trimetoprim endovenoso, associado a dexametasona, e, posteriormente, itraconazol oral. The authors report a case of a 55 year-old heavysmoking man, and presented with an acute case of paraparesis, constipation and urinary retention. The patient had an ulcerative soft-palate lesion, which was negative for malignancy. With a diagnosis of spinal cord syndrome, we performed tests that showed a normal cerebrospinal fluid. The chest X-ray showed nodular bilateral opacities, and the lumbosacral MRI presented with small ring-shaped contrast-enhanced lesions on the spinal cord, with perilesional edema, probably related to an infectious process. A new mucous lesion biopsy was performed, and it was positive for south-american blastomicosis, leading us to assume the medular lesion was secondary to Paracoccidioidis braziliensis infection, since this is what happens on the majority of rare cases of spinal cord affections on this disease. After 6 months, the patients walked without support, keeping the need for intermittent urinary catheter, after initial intravenous treatment with sulfamethoxazole and trimethoprim, associated with dexamethasone, and after that oral itraconazole.