1/27. central nervous system histoplasmosis mimicking a brain tumor: difficulties in diagnosis and treatment.Neurologic involvement occurs in 10% to 20% of patients with disseminated histoplasmosis. We describe a 20-year-old woman who had headache and diplopia but no evidence of systemic infection. magnetic resonance imaging showed an enhancing mass in the thalamomesencephalic and third ventricular region. After subtotal resection of what was presumed to be a glioma, the patient had symptoms and signs of meningitis. Subsequent pathological review demonstrated noncaseating granulomas, and serologic tests and cultures confirmed the diagnosis of histoplasmosis. Initiation of antifungal therapy and removal of an infected shunt system resulted in clinical improvement. Clinicians should maintain a high index of suspicion in patients who are from any area endemic for histoplasmosis.- - - - - - - - - - ranking = 1keywords = nervous system, brain (Clic here for more details about this article) |
2/27. A case of hiv-associated cerebral histoplasmosis successfully treated with fluconazole.Clinically apparent involvement of the central nervous system is a rare event in cases of disseminated histoplasmosis, even in hiv-infected persons. Despite therapy with amphotericin b, mortality remains very high. Reported here is the case of an hiv-infected patient with a 3-month history of fever, cough, weight loss and miliary lung infiltrates. Four weeks after initiation of tuberculostatic therapy, high-grade fever, neurological symptoms, personality changes and respiratory deterioration occurred. magnetic resonance imaging of the brain showed multiple mass lesions, and a chest radiograph revealed worsening of pulmonary infiltrates. methenamine silver staining of a lung biopsy specimen demonstrated histoplasma capsulatum. Subsequently, this pathogen was cultured from lavage fluid. Following high-dose intravenous fluconazole therapy (800 mg once daily), the patient's condition improved markedly within 10 days, followed by an almost complete resolution of pulmonary and cerebral mass lesions. This is believed to be the first documented case of rapid improvement of disseminated histoplasmosis with central nervous system involvement in an hiv-infected patient upon induction of therapy with fluconazole.- - - - - - - - - - ranking = 2.0487148660088keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
3/27. Prostatic and central nervous system histoplasmosis in an immunocompetent host: case report and review of the prostatic histoplasmosis literature.histoplasmosis is a common cause of systemic mycosis in areas of the united states where it is endemic. central nervous system and genitourinary histoplasmosis is rare, especially in immunocompetent hosts. We describe a case of disseminated histoplasmosis in a normal host that was associated with cerebral and prostatic histoplasmosis presenting as fever of undetermined origin, weight loss, and severe debilitating altered mental status. The patient subsequently developed acute renal failure that manifested as obstructive uropathy during antifungal therapy with amphotericin b. Transurethral resection of the prostate resulted in improved renal function during continuation of amphotericin b therapy. Pathological analysis of the prostate revealed necrotizing granulomas with intralesional fungal organisms. blood and urine cultures were positive for histoplasma capsulatum. Diagnostic issues and management are discussed. Treatment resulted in return of normal cognitive and motor function. This case is compared with the 8 previously reported cases of H. capsulatum prostatitis.- - - - - - - - - - ranking = 4.3160080439275keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/27. meningoencephalitis caused by histoplasma capsulatum: occurrence in a renal transplant recipient and a review of the literature.A case of meningoencephalitis caused by histoplasmosis in a renal transplant patient is described. The diagnosis was made postmortem. The clinicopathological features of 39 additional cases of central nervous system (CNS) invasion by histoplasmosis were reviewed. In the great majority of instances (92.1%), CNS involvement occurred in the disseminated form of the disease. Diagnosis was proved by culturing the fungus from bone marrow, blood, lymph nodes, or liver. Neurological symptoms and signs and cerebrospinal fluid (CSF) changes did not occur until extensive brain damage had resulted. Difficulty in culturing the organism in the (CSF) caused a further delay in making an early diagnosis of CNS involvement. The use of meningeal and brain biopsy specimens in conjunction with the electroencephalogram (EEG) may help in making an earlier diagnosis of CNS involvement.- - - - - - - - - - ranking = 1.0400682770495keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
5/27. Solitary parietal lobe histoplasmoma mimicking a brain tumor.We describe a rare case of histoplasma infection, which manifested only as a brain histoplasmoma, in a previously healthy woman who had no underlying predisposing conditions. Only a few cases of such intracranial histoplasmomas have been reported but this entity can mimic a brain neoplasm and should be a diagnostic consideration during the evaluation of ring-enhancing brain lesions.- - - - - - - - - - ranking = 0.073317272210276keywords = brain (Clic here for more details about this article) |
6/27. Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature.An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function. magnetic resonance imaging demonstrated a ring-enhancing intramedullary lesion at T2 and signal abnormality from C2 to T5. Emergent T2-T3 laminectomy was performed with ultrasonographically guided intradural exploration and midline myelotomy. The intramedullary abscess was drained. She was nonambulatory, but motor function was partially restored. An Ommaya reservoir was later placed to deliver amphotericin and a new antifungal agent, voriconazole. magnetic resonance imaging confirmed that the infection had resolved. Intramedullary spinal histoplasmoma is a rare manifestation of disseminated histoplasmosis, particularly in nonendemic regions. Surgery for focal mass lesions and aggressive antifungal chemotherapy are the optimal treatment. Newer central nervous system-penetrating antibiotics show promise in refractory cases.- - - - - - - - - - ranking = 1.0191204849894keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/27. Cerebral histoplasmosis in the azole era: report of four cases and review.We report four cases of cerebral histoplasmosis and discuss features of six additional cases reported in the medical literature in the past 10 years, when azoles have been available for therapy. Most patients with this disease are immunocompromised or have a history that suggests heavy exposure to histoplasma capsulatum. fever and other clinical findings of systemic toxicity caused by disseminated histoplasmosis may be absent; 5 of 10 patients did not manifest these findings. Although the mainstay of treatment for central nervous system histoplasmosis remains amphotericin b, 9 of the 10 patients received itraconazole or fluconazole either as initial therapy or after a course of treatment with amphotericin b.- - - - - - - - - - ranking = 1.0191204849894keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/27. Disseminated histoplasmosis with unusual cutaneous lesions in a patient from the philippines.The incidence and prevalence of histoplasmosis in Southeast asia has not been extensively described. The first microbiologically documented case of disseminated histoplasmosis with cutaneous papulonodules in a 56-year-old woman from the philippines is reported. She presented with fever and generalized papulonodular lesions in various stages, which evolved into vesicles with central necrosis that resembled molluscum contagiosum with an indurated erythematous halo. Biopsies revealed a granulomatous mass of lymphohistiocytic and epithelioid cells with intracellular budding yeast cells and dark nuclei. Cultures were positive for histoplasma capsulatum. The patient was treated with amphotericin b (3 g) and 5-fluorocytosine (50 mg/kg/day), followed by ketoconazole (400 mg/day). Her clinical course was complicated by intractable hemolytic anemia that was initially treated with corticosteroids. A splenectomy was subsequently performed. pneumonia and a brain abscess caused by nocardia asteroides were secondary complications. Nine months after her admission, repeat testing was diagnostic for systemic lupus erythematosus. This patient serves to re-emphasize that cutaneous lesions in an immunocompromised patient must be evaluated by biopsy and culture analysis. Disseminated histoplasmosis in the immunocompromised host may present with unusual cutaneous lesions, and must be considered even in a nonendemic area.- - - - - - - - - - ranking = 0.010473896030039keywords = brain (Clic here for more details about this article) |
9/27. Chronic histoplasma capsulatum infection of the central nervous system successfully treated with fluconazole.A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin b, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.- - - - - - - - - - ranking = 4.0764819399576keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/27. Unusual patterns of histoplasma capsulatum meningitis and progressive multifocal leukoencephalopathy in a patient with the acquired immunodeficiency virus.Disseminated histoplasmosis (DH) and progressive multifocal leukoencephalopathy occur in acquired immunodeficiency syndrome (AIDS). At autopsy, DH patients with central nervous system involvement almost always show extensive involvement of the lungs and reticuloendothelial system in addition to the brain, and progressive multifocal leukoencephalopathy is manifest as multiple demyelinating lesions in several locations in the brain. We describe an AIDS patient with a long history of aggressively treated DH who died with DH in the brain only; fungus was not found elsewhere at autopsy. In addition, there was a papovavirus infection restricted to the cerebellum with predominant involvement of the internal granular cell layer; again, demyelinating lesions were not found elsewhere in the brain. Each of these patterns of brain involvement is rare. As the incidence of AIDS increases and patients are treated aggressively, the frequency of unusual neuropathologic patterns of opportunistic infections may be expected to increase.- - - - - - - - - - ranking = 1.0714899651396keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
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