BACKGROUND:Leishmaniasis is caused by protozoans that depend on female phlebotomine sandflies as vectors. The natural habitat of these sandflies is changing due to climatic changes, affecting the immunocompromised population, as more patients get immunocompromised due to cancer therapy in the present time.CASE REPORT:We report the case of a 72-year-old patient with melanoma in whom we found visceral leishmaniasis mimicking hepatic metastasis in routine FDG-PET/CT. The patient was hospitalised due to fever and pancytopenia in the general hospital Steyr. The diagnosis was made by biopsy of the iliac crest with cytological study and polymerase chain reaction. After treatment with amphotericin B, the patient recovered and tests became negative, including FDG-PET/CT. Because of climate change and the increasing use of immunomodulatory medication, our awareness of such findings should grow.CONCLUSION:New pitfalls in diagnosis and surveillance of cancer patients because of altered environmental conditions and immunocompromised patients have to be taken into account.

Abstract Background Beta amyloid (Aβ) causes synaptic dysfunction leading to neuronal death. It is still controversial if the magnitude of Aβ deposition correlates with the degree of cognitive impairment. Diagnostic imaging may lead to a better understanding the role of Aβ in development of cognitive deficits. The aim of the present study was to investigate if Aβ deposition in the corresponding brain region of early stage Alzheimer´s disease (AD) patients, directly correlates to neuronal dysfunction and cognitive impairment indicated by reduced glucose metabolism. Patients and methods In 30 patients with a clinical phenotype of AD and amyloid positive brain imaging, 2-[18F] fluoro-2-deoxy-d-glucose (FDG) PET/CT was performed. We extracted the average [18F] flutemetamol (Vizamyl) uptake for each of the 16 regions of interest in both hemispheres and computed the standardized uptake value ratio (SUVR) by dividing the Vimazyl intensities by the mean signal of positive and negative control regions. Data were analysed using the R environment for statistical computing and graphics. Results Any negative correlation between Aβ deposition and glucose metabolism in 32 dementia related and corresponding brain regions in AD patients was not found. None of the correlation coefficient values were statistically significant different from zero based on two-sided p- value. Conclusions Regional Aβ deposition did not correlate negatively with local glucose metabolism in early stage AD patients. Our findings support the role of Aβ as a valid biomarker, but does not permit to conclude that Aβ is a direct cause for an aberrant brain glucose metabolism and neuronal dysfunction.

Fungal infections of the brain are seen among immunocompromised individuals (transplant patients, HIV-infected patients, cancer patients undergoing chemotherapy, and hospitalized people with serious underlying diseases). The clinical signs are variable. Based on morphology and mode of spore production, fungi are classified as yeasts (unicellular) or molds (multicellular organisms). The most common infectious agents include Aspergillus spp., Cryptococcus neoformans, Histoplasma capsulatum, and Candida ssp. In general, multiple parenchymal lesions with variable parenchymal and leptomeningeal enhancement are detected using radiologic imaging techniques. With the use of special stains (Gomori methenamine silver, Grocott, perjodic acid-Schiff, mucicarmine, Gram stain, and Giemsa stain) the agents can be visualized and their morphology (septation, branching, budding, hyphae) determined. Treatment is performed with antifungal agents. Clinical outcome depends on the sanitation of the primary focus and the state of immunodeficiency or immunocompetence.

Primary non-neoplastic cystic lesions of the nervous system with space-occupying character include epidermoid cyst, dermoid cyst, colloid cyst of the third ventricle, Rathke’s cleft cyst, enterogeneous cyst, neuroglial cyst, congenital arachnoid cyst, pineal cyst, choroid plexus cyst, and perineurial cyst. Epidermoid cyst is lined by a delicate layer of keratin-producing squamous epithelial cells containing keratohyalin granules. The underlying stroma is scant. The cyst arises from inclusions of embryonal ectodermal elements during closure of the primitive neural groove or the secondary cerebral vesicles. Surgical excision is the treatment of choice; prognosis is good. Dermoid cyst is lined by squamous epithelium with underlying dermal appendages, including hair follicles and adnexae. It arises from inclusions of embryonal ectodermal elements during closure of the primitive neural groove or the secondary cerebral vesicles. Surgical excision is the treatment of choice; prognosis is good. Rathke’s cleft cyst is an intra- or suprasellar cyst lined by ciliated, cuboidal to columnar epithelium, goblet cells, and occasional pituitary endocrine cells. It is thought to represent fragments of a blind-ended evagination of the ectodermally lined stomatodeum. Surgical excision is the treatment of choice; prognosis is good. Colloid cyst of the third ventricle is a lesion lined by cuboidal to columnar, ciliated, and/or goblet cells which may become flattened and atrophic under pressure. The cyst occurs in the anterior third ventricle near the foramen of Monro. It is sought to originate from persisting embryological remnants. Surgical excision is the treatment of choice; prognosis is good. Enterogeneous cyst is lined by mucin-secreting and/or ciliated, cuboidal to columnar epithelium resembling that of the respiratory and intestinal tract. It is sought to result from an anomalous embryological connection between the primitive foregut and the developing neural tube. It is associated with vertebral malformations. Surgical excision is the treatment of choice; prognosis is good. Arachnoidal cyst consists of flattened arachnoidal cells which rest on a thin, vascularized collagenous membrane. It results from the focal splitting of the arachnoid membrane. Surgical excision is the treatment of choice; prognosis is good. Contents may reaccumulate after simple aspiration.