{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:05:06Z","timestamp":1790661906434,"version":"4.1.0"},"reference-count":18,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Brain paracoccidioidomycosis (PCM) or neuroparacoccidioidomycosis (NPCM) is a fungal infection of the central nervous system (CNS) caused by <jats:italic>Paracoccidioides brasiliensis<\/jats:italic>, a dimorphic fungus. The CNS involvement is through bloodstream dissemination. The association between NPCM and systemic lupus erythematous (SLE) is rare. However, SLE patients are under risk of opportunistic infections given their immunosuppression status.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>The aim of this case report is to present a 37-year-old female with diagnosis of SLE who presented with progressive and persistent headache in the past 4 months accompanied by the right arm weakness with general and neurologic examination unremarkable. The computerized tomography of the head showed left extra-axial parietooccipital focal hypoattenuation with adjacent bone erosion. The brain magnetic resonance imaging reported left parietooccipital subdural collection associated with focal leptomeningeal thickening with restriction to diffusion and peripheral contrast enhancement. The patient underwent a left craniotomy and dura mater biopsy showed noncaseous granulomatosis with multinucleated giant cells with rounded birefringent structures positive for silver stain, consistent with PCM. Management with itraconazole 200 mg daily was started with a total of 12 months of treatment, with patient presenting resolution of headache and right arm weakness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>The diagnosis of NPCM is challenging and a high degree of suspicious should be considered in patients with persistent headache and immunosuppression.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_1012_2021","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:50:58Z","timestamp":1638298258000},"page":"581","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Brain paracoccidioidomycosis in an immunosuppressed patient with systemic lupus erythematosus"],"prefix":"10.25259","volume":"12","author":[{"given":"Carolina","family":"Kamer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Centro Universit\u00e1rio para o Desenvolvimento do Alto Vale do Itaja\u00ed, Rio do Sul, Santa Catarina, Brazil,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara Janke","family":"Pretto","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Rheumatology and Immunotherapy Center of Alto Vale, Rio do Sul, Santa Catarina, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Rafael","family":"Livramento","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Centro Universit\u00e1rio para o Desenvolvimento do Alto Vale do Itaja\u00ed, Rio do Sul, Santa Catarina, Brazil,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Carlos","family":"da Silva","sequence":"additional","affiliation":[{"name":"Graduate Medical Education, Piedmont Athens Regional Medical Center, Athens, Georgia, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"10.25259\/SNI_1012_2021\/ref-1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/978-3-030-06088-6_4","article-title":"Pathogenesis of fungal infections","volume-title":"Fungal Infections of the Central Nervous System, Pathogens, Diagnosis, and Management","author":"Banushree","year":"2019"},{"key":"10.25259\/SNI_1012_2021\/ref-2","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1590\/S0004-282X2000000400024","article-title":"Paracoccidioidomycosis of the central nervous system: Case report","volume":"58","author":"Da Silva","year":"2000","journal-title":"Arq Neuropsiquiatr"},{"key":"10.25259\/SNI_1012_2021\/ref-3","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3390\/jof6040303","article-title":"Neuroparacoccidioidomycosis: A 13-year cohort study, Rio de Janeiro, Brazil","volume":"6","author":"De Macedo","year":"2020","journal-title":"J Fungi (Basel)"},{"key":"10.25259\/SNI_1012_2021\/ref-4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1590\/S0037-86822011000100006","article-title":"Long-term outcome of neuroparacoccidioidomycosis treatment","volume":"44","author":"Francesconi","year":"2011","journal-title":"Rev Soc Bras Med Trop"},{"key":"10.25259\/SNI_1012_2021\/ref-5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/978-3-030-56084-3_10","article-title":"Fungal Infections of the brain","volume-title":"Neurological Complications of Infectious Diseases","author":"Gonzalez-Lara","year":"2021"},{"key":"10.25259\/SNI_1012_2021\/ref-6","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1080\/00365540902744741","article-title":"Incidence and risk factors of infection in a single cohort of 110 adults with systemic lupus erythematosus","volume":"41","author":"Jeong","year":"2009","journal-title":"Scand J Infect Dis"},{"key":"10.25259\/SNI_1012_2021\/ref-7","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3390\/jof5030064","article-title":"Central nervous system infection with other endemic mycoses: Rare manifestation of blastomycosis, paracoccidioidomycosis, talaromycosis, and sporotrichosis","volume":"5","author":"Kauffman","year":"2019","journal-title":"J Fungi (Basel)"},{"key":"10.25259\/SNI_1012_2021\/ref-8","first-page":"224","article-title":"Paracoccidioidomicose associada por droga imunossupressora em paciente com lupus eritematoso sist\u00eamico","volume":"13","author":"Londero","year":"1987","journal-title":"J Pneumol"},{"key":"10.25259\/SNI_1012_2021\/ref-9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1590\/S0036-46652015000700004","article-title":"Epidemiology of paracoccidioidomycosis","volume":"57","author":"Martinez","year":"2015","journal-title":"Rev Inst Med Trop Sao Paulo"},{"key":"10.25259\/SNI_1012_2021\/ref-10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.2174\/1874285801711010224","article-title":"Paracoccidioidomycosis: Current perspectives from Brazil","volume":"11","author":"Mendes","year":"2017","journal-title":"Open Microbiol J"},{"key":"10.25259\/SNI_1012_2021\/ref-11","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.1212\/NXI.0000000000000519","article-title":"Neuroparacoccidioidomycosis","volume":"6","author":"Neto","year":"2019","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"10.25259\/SNI_1012_2021\/ref-12","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1590\/S0037-86822009000600016","article-title":"Paracoccidioidomycosis compromising the central nervous system: A systematic review of the literature","volume":"42","author":"Pedroso","year":"2009","journal-title":"Rev Soc Bras Med Trop"},{"key":"10.25259\/SNI_1012_2021\/ref-13","doi-asserted-by":"crossref","first-page":"ofaa077","DOI":"10.1093\/ofid\/ofaa077","article-title":"Delayed relapse of paracoccidioidomycosis in the central nervous system: A case report","volume":"7","author":"Rahman","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"10.25259\/SNI_1012_2021\/ref-14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.25259\/SNI_224_2020","article-title":"Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease","volume":"11","author":"Riechelmann","year":"2020","journal-title":"In Surg Neurol Int"},{"key":"10.25259\/SNI_1012_2021\/ref-15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ejrad.2018.03.026","article-title":"Imaging paracoccidioidomycosis: A pictorial review from head to toe","volume":"103","author":"Rosa","year":"2018","journal-title":"Eur J Radiol"},{"key":"10.25259\/SNI_1012_2021\/ref-16","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1590\/0037-8682-0230-2017","article-title":"Brazilian guidelines for the clinical management of paracoccidioidomycosis","volume":"50","author":"Shikanai-Yasuda","year":"2017","journal-title":"Rev Soc Bras Med Trop"},{"key":"10.25259\/SNI_1012_2021\/ref-17","first-page":"e0500001","article-title":"Brazilian guidelines for the clinical management of paracoccidioidomycosis","volume":"27","author":"Shikanai-Yasuda","year":"2018","journal-title":"Epidemiol Serv Saude"},{"key":"10.25259\/SNI_1012_2021\/ref-18","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.3899\/jrheum.150142","article-title":"A multicenter study of invasive fungal infections in patients with childhood-onset systemic lupus erythematosus","volume":"42","author":"Silva","year":"2015","journal-title":"J Rheumatol"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/brain-paracoccidioidomycosis-in-an-immunosuppressed-patient-with-systemic-lupus-erythematosus\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/brain-paracoccidioidomycosis-in-an-immunosuppressed-patient-with-systemic-lupus-erythematosus\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:51:15Z","timestamp":1638298275000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/brain-paracoccidioidomycosis-in-an-immunosuppressed-patient-with-systemic-lupus-erythematosus\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":18,"alternative-id":["10.25259\/SNI_1012_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_1012_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,30]]},"article-number":"581"}}