Leucoencefalopatia multifocal progressiva e paracoccidioidomicose disseminada em paciente com AIDS

Abstract

A 39-year-old man with a previous diagnosis of acquired immunodeficiency syndrome (AIDS) was admitted to hospital with a 2-week history of fever, weight loss, headache, diplopia and confusion. His last CD4 + count was of 9 cells/mm 3 . Physical examination revealed painful and enlarged cervical, axillary and inguinal lymph nodes and ptosis of the left eyelid. Magnetic resonance (MR) showed a tumoral lesion in the cavernous sinus with a left internal carotid artery displacement (Figure A). MR also revealed another bilateral cerebral lesion suggestive of progressive multifocal leukoencephalopathy surrounding the third ventricle (Figure B). A cervical lymph node biopsy showed numerous leveduriform structures of Paracoccidioid es brasiliensis (Figure C). He was treated with conventional amphotericin B for 36 days followed by itraconazole for 21 days with a slow and progressive recovery. Just before dismissal he was started on HAART (tenofovir, lamivudine, efavirenz). Four months later, at the outpatient clinic, he was asymptomatic.