MRI of Central Nervous System Paracoccidioidomycosis (PCM)

The actual frequency of paracoccidioidomycosis of the central nervous system (CNS) is not known, because neurological investigation of the patients is not routinely done and in many cases the CNS involvement may be silent [1]. The incidence of CNS involvement in several studies varied from 10 to 27 % [2]. Of the relatively small number of cases reported in the literature, the two most common clincal presentations are the meningeal and pseudotumoral (parenchymatous) forms, being the last most common. The granulomatous lesions may be single or multiple, with various sizes, and have been described predominantly in brain hemispheres in relation to the cerebellum and the brain stem. In addition, most cases were associated with PCM involvement of other organs, mainly lungs [3]. MRI has been shown superior to CT in the evaluation of neuroparacoccidioidomycosis [4], but only a small number of cases has been studied by MRI. The first aim of this study was to assess the frequency of CNS lesions in a series of PCM patients consecutively diagnosed at a Brazilian reference center. In addition, this study was also designed to characterize better the imaging features and the preferential localization of PCM lesions of the CNS.