Bronchial stenosis secondary to systemic paracoccidioidomycosis

A 65-year-old man presented with dyspnea during moderate physical exertion, a persistent nonproductive cough, and progressive clinical deterioration. Upon examination, a perforated nasal septum was observed, along with decreased breath sounds on the right side and expiratory stridor. Paraclinical tests revealed a high neutrophil count in the blood, and contrast-enhanced chest tomography showed total stenosis of the right main bronchus (Figure 1). Further investigations, including spirometry, bronchoscopy, and nasal mucosa biopsy, confirmed the presence of Paracoccidioides spp. (Figure 2 and 3). The patient was treated with amphotericin B deoxycholate, followed by a 6-month course of itraconazole. Follow-up assessments indicated satisfactory progress, with improved symptoms and no need for supplemental oxygen at the time of hospital discharge.

FIGURE 1:
Chest tomography. Evidence of total stenosis of the right source bronchus.

FIGURE 2:
Microphotograph of mucosa of the nasal septum (400×). Granulomas with multinucleated giant cells and multigerm yeast inside (arrows).

FIGURE 3:
Morphological details of Paracoccidioides spp. revealing a distinctive "ship's wheel" morphology, as observed using Grocott's methenamine silver stain.

Paracoccidioidomycosis, a systemic fungal infection caused by Paracoccidioides spp., is primarily contracted through the inhalation of spores¹. The infection can manifest as an acute/subacute form affecting 5-25% of those infected, or as a chronic form, which manifests gradually with symptoms such as cough, dyspnea, and physical manifestations including skin and oral lesions². Notably, right source bronchus stenosis as a manifestation of Paracoccidioidomycosis is exceedingly rare. Although Paracoccidioidomycosis is more prevalent in South America, particularly in Colombia and Brazil, it has been reported globally, albeit in limited cases³. Recognizing this systemic manifestation is crucial in the differential diagnosis of respiratory conditions or granulomatous diseases involving the airways.

ETHICAL CONSIDERATIONS

The study was approved by the Hospital Universitario de Santander Ethics Committee.

ACKNOWLEDGMENTS

Thanks to Hospital Universitario de Santander, which provided the means for the development and implementation of this study.

REFERENCES

• ¹
  Queiroz FV, Peçanha PM, Rosa M, Baptista RM. New insights on pulmonary paracoccidioidomycosis. Semin Respir Crit Care Med. 2020;41(1):68-53.
• ²
  Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai MA, Soares MS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol. 2013;8(9):1177-91.
• ³
  Peçanha PM, Peçanha PM, Grão TR, Rosa M, Falqueto A, Gonçalves SS. Paracoccidioidomycosis: What we know and what is new in epidemiology, diagnosis, and treatment. J Fungi. 2022;8(10):1098.

• Financial Support: We did not receive any financial support for the publication of this article.

Publication Dates

• Publication in this collection
  22 Sept 2023
• Date of issue
  2023

History

• Received
  17 July 2023
• Accepted
  03 Aug 2023