Teaching NeuroImage: Disseminated Paracoccidioidomycosis Presenting With Psychiatric Symptoms and Focal Epilepsy
Year: 2026
Type: article
Study design: Case Report
Abstract: A 58-year-old hypertensive man with alcohol use disorder from rural Southeast Brazil presented with a 2-week history of recurrent confusional episodes and right facial focal seizures evolving to bilateral tonic-clonic seizures.He also complained of a dry cough, and his physical examination showed bibasilar crackles and lesions in the oral cavity (Figure 1).Neurologic examination was notable only for a mild cerebellar gait ataxia.Brain MRI showed multiple ring-enhancing nodular lesions (Figure 1).CSF analysis revealed mild pleocytosis, hypoglycorrhachia, and elevated protein, with negative bacterial, mycobacterial, and fungal studies.HIV testing was negative.Chest CT showed bilateral pulmonary opacities and micronodules.Biopsy of the oral ulcerative lesions identified multiple budding yeast cells with a characteristic pilot-wheel configuration, consistent with Paracoccidioides spp (Figure 2).A diagnosis of disseminated paracoccidioidomycosis with CNS involvement was established. 1 A 2-year treatment with sulfamethoxazole-trimethoprim and antiseizure therapy led to progressive clinical and imaging improvement.2
Source: Neurology
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7214997818