Infratentorial neuroparacoccidioidomycosis: A case report

Background: Neurological manifestations of paracoccidioidomycosis are uncommon, and the clinical presentation can include a variety of symptoms that depends specially on the lesion's site. Case Description: This article reports the case of a 63-year-old rural worker who presented with progressive imbalance and diplopia. Magnetic resonance imaging suggested a likely inflammatory/infectious etiology. The diagnosis was confirmed by the intraoperative frozen section and direct microscopic examination. Treatment started with amphotericin B and, later on, with itraconazole due to decreased renal function. The patient responded well and had improvement in symptoms. Conclusion: Being aware of the patient environment is crucial for diagnosing neuroparacoccidioidomycosis. A detailed anamnesis, with description of professional and residence location, as well as other risky activities, should be done. The treatment must be individualized depending on clinical conditions and comorbidities, but amphotericin B and itraconazole are the most indicated and standardized options.