Central nervous system (CNS) infection by Histoplasma capsulatum is a rare disease in immunocompromised individuals in endemic areas. About one quarter of cases result from hematogenous dissemination. A 23-year-old upholsterer with chronic occipital headache had developed intracranial hypertension and dizziness, incoordination with ataxic gait, and acute confusion 5 months prior to admission. Laboratory examinations and chest roentgenogram were normal. Postcontrast T1-weighted MRI of the brain revealed a multiple ring-enhancing cerebellar, brain stem and parietal lobe lesions, and meningeal contrast enhancement. Cerebrospinal fluid culture was positive for H. capsulatum species complex, which was confirmed by phylogenetic analysis. Thirteen years after the diagnosis and treatment, there was no H. capsulatum recurrence; sequels related to complications due to the ventriculoperitoneal shunt. This case shows a primary neurological presentation of cerebral histoplasmosis, without meningitis or disseminated disease in nonimmune-compromised patient. The authors propose a categorization of the diagnosis of CNS histoplasmosis. Routine diagnostics of sibling species within the H. capsulatum complex proved to be difficult.

中文翻译：

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免疫功能正常的成人中组织胞浆菌引起的原发性中枢神经系统感染

由荚膜组织胞浆菌引起的中枢神经系统 (CNS) 感染是流行地区免疫功能低下个体的罕见疾病。大约四分之一的病例是由血行播散引起的。一名患有慢性枕部头痛的 23 岁室内装潢师在入院前 5 个月出现颅内高压和头晕、共济失调步态不协调和急性意识模糊。实验室检查和胸片正常。脑的增强后 T1 加权 MRI 显示多处环状增强小脑、脑干和顶叶病变，以及脑膜对比增强。脑脊液培养对 H. capsulatum 物种复合体呈阳性，系统发育分析证实了这一点。诊治十三年后，无荚膜幽门螺杆菌复发；与脑室腹腔分流术并发症相关的后遗症。该病例显示脑组织胞浆菌病的原发性神经系统表现，在非免疫功能低下的患者中没有脑膜炎或播散性疾病。作者建议对 CNS 组织胞浆菌病的诊断进行分类。H. capsulatum 复合体中同胞物种的常规诊断被证明是困难的。