We describe the case of a 62-year-old man, who presented with a new onset of focal seizures of his right leg. There were no other clinical symptoms, and laboratory results were normal. Brain magnetic resonance imaging revealed multiple lesions, two supratentorial lesions were ring-enhancing. The brain biopsy tissue showed Histoplasma capsulatum abscesses. He improved on treatment with Amphotericin B. This case is reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, which is also rare in an immunocompetent individual. We review the literature and discuss the radiologic and pathologic findings of this case compared with previous reports.
SaccenteM. Central nervous system histoplasmosis. Curr Treat Options Neurol.2008; 10 (3): 161–167. doi: 10.1007/s11940-008-0017-x.
3.
MedoffGKobayashiGSPainterA: Morphogenesis and pathogenicity of Histoplasma capsulatum. Infect Immun.1987; 55 (6): 1355–1358.
4.
PariharATomarVOjhaBK. Magnetic resonance imaging findings in a patient with isolated histoplasma brain abscess. Arch Neurol.2011; 68 (4): 534–535. doi: 10.1001/archneurol.2011.59.
5.
ZalduondoFMProvenzaleJMHuletteC. Meningitis, vasculitis, and cerebritis caused by CNS histoplasmosis: Radiologic-pathologic correlation. Am J Roentgenol.1996; 166 (1): 194–196. doi: 10.2214/ajr.166.1.8571874.
6.
AssiMASandidMSBaddourLM. Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients. Medicine (Baltimore).2007; 86 (3): 162–169. doi: 10.1097/md.0b013e3180679130.
7.
WheatLJBatteigerBESathapatayavongsB. Histoplasma capsulatum infections of the central nervous system. A clinical review. Medicine (Baltimore).1990; 69 (4): 244–260. doi: 10.1097/00005792-199007000-00006.
SchusterJEIWushenskyCADi PentimaMC. Chronic primary central nervous system histoplasmosis in a healthy child with intermittent neurological manifestations. Pediatr Infect Dis J.2013; 32 (7): 794–796. doi: 10.1097/INF.0b013e31828d293e.
10.
SchestatskyPChedidMFAmaralOB. Isolated central nervous system histoplasmosis in immunocompetent hosts: a Series of 11 cases. Scand J Infect Dis.2006; 38 (1): 43–48. doi: 10.1080/00365540500372895.
11.
ThrelkeldZDBroughtonRKhanGQ. Isolated Histoplasma capsulatum meningoencephalitis in an immunocompetent child. J Child Neurol.2012; 27 (4): 532–535. doi: 10.1177/0883073811428780.
12.
LuthraGPariharANathK. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. Am J Neuroradiol.2007: 28 (7): 1332–1338. doi: 10.3174/ajnr.A0548.
13.
NguyenFNKarJKZakariaA. Isolated central nervous system histoplasmosis presenting with ischemic pontine stroke and meningitis in an immunocompetent patient. JAMA Neurol.2013; 70 (5): 638–641. doi: 10.1001/jamaneurol.2013.1043.
