Paracoccidioidomycosis in a patient with cervical cancer

Marques, Silvio Alencar; Lastória, Joel Carlos; Marques, Mariangela Esther Alencar

doi:10.1590/S0365-05962011000300029

Abstracts

This report describes the case of a female patient with paracoccidioidomycosis associated with a stage IIIB cervical carcinoma. Paracoccidioidomycosis in association with a malignant tumor occurs in 0.16% to 14.1% of cases in accordance with different case series. In cases in which the cancer is disseminated, the fungal infection may behave opportunistically

Carcinoma; Mycosis; Paracoccidioidomycosis; Uterine cervical neoplasms

Os autores relatam caso de paciente do sexo feminino com paracoccidioidomicose, associada a carcinoma do colo uterino estádio IIIB. Paracoccidioidomicose, associada à neoplasia, ocorre entre 0,16% a 14,1% segundo diferentes séries de casos. Em casos com neoplasia disseminada a infecção fúngicas pode apresentar comportamento oportunístico

Carcinoma; Micoses; Neoplasias do colo do útero; Paracoccidioidomicose

IMAGES IN TROPICAL DERMATOLOGY

Paracoccidioidomycosis in a patient with cervical cancer^*

Silvio Alencar Marques^I; Joel Carlos Lastória^II; Mariangela Esther Alencar Marques^III

^IFaculty Member. Associate Professor, Department of Dermatology and Radiotherapy, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil

^IIFaculty Member. Associate Professor, Department of Dermatology and Radiotherapy, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil

^IIIFaculty Member. Associate Professor, Pathology Department, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil

Mailing address

ABSTRACT

This report describes the case of a female patient with paracoccidioidomycosis associated with a stage IIIB cervical carcinoma. Paracoccidioidomycosis in association with a malignant tumor occurs in 0.16% to 14.1% of cases in accordance with different case series. In cases in which the cancer is disseminated, the fungal infection may behave opportunistically.

Keywords: Carcinoma; Mycosis; Paracoccidioidomycosis; Uterine cervical neoplasms

A 41-year old female cleaner from Igaraçu do Tietê in the state of São Paulo, who had previously lived in a rural area of the same region, was being followed up for a stage IIIB cervical carcinoma. At the time the patient was seen at the dermatology department, she had been undergoing radiotherapy and reported the appearance of a skin lesion three months previously, coinciding with clinical deterioration of her primary disease. Examination revealed a single ulcerated, non-exudative lesion with a granular base and hemorrhagic spots, infiltrated borders and a mildly erythematous halo, measuring 3.0 cm in diameter and situated on the lateral surface of her left arm (Figures 1 and 2). The clinical hypotheses were paracoccidioidomycosis and leishmaniasis. Anatomopathological examination confirmed diagnosis of paracoccidioidomycosis following a finding of typical multiple budding cells. This was corroborated by positivity for the specific serological test and because of the interstitial pattern of the associated pulmonary involvement (Figures 3 and 4). Progression was determined by the primary disease and the patient died one month after diagnosis of the fungal infection.

Paracoccidioidomycosis is a systemic infection that involves the skin in 31.2% to 54.2% of cases. ^1,2Paracoccidioidomycosis associated with malignancy is reported to occur in 0.16% to 14.1% of cases (mean 3.96%), the most commonly associated malignancy being carcinoma. ³Compared to Histoplasma capsulatum and even Sporothrix schenckii, Paracoccidioides brasiliensis does not fit the profile of an opportunistic fungus; however, in endemic countries, it would be no surprise to find its diagnosis associated with a clinical status of immunosuppression.^4,5

REFERENCES

1 Robledo M, Arango M, Restrepo A. Polimorfismo de las lesiones cutáneas en la paracoccidioidomicosis. Rev Arg Micol. 1992;15:166.
2 Marques SA Cortez D, Lastória JC, Camargo RMP, Marques MEA. Paracoccidioidomycosis: frequency, morphology and pathogenesis of tegumentary lesions. An Bras Dermatol. 2007;82:411-7.
3 Shikanai-Yasuda MA, Conceição YMT, Kono A, Rivitti E, Campos AF, Campos SV. Neoplasia and paracoccidioidomycosis. Mycopathologia 2008;165:303-12.
4 Marques SA. Paracoccidioidomicose e esporotricose associada à imunossupressão. Med Cut Iber Lat Am. 2009;37:159-70.
5 Gutiérrez-Galhardo MC, Francisconi do Valle A, Fraga B, Schubach AO, Hoagland BR, Monteiro PC, et al. Disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome. Mycoses. 2010;53:78-80.

Endereço para correspondência:

Silvio Alencar Marques

Rua Costa Leite, 515

18600-010 Botucatu-SP

*

Trabalho realizado no Departamento de Dermatologia e Radioterapia Faculdade de Medicina de Botucatu Universidade Estadual Paulista (Unesp) - São Paulo (SP), Brasil.

Publication Dates

Publication in this collection
21 June 2011
Date of issue
June 2011

History

Received
05 May 2010

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 Robledo M, Arango M, Restrepo A. Polimorfismo de las lesiones cutáneas en la paracoccidioidomicosis. Rev Arg Micol. 1992;15:166.

[2] 2 Marques SA Cortez D, Lastória JC, Camargo RMP, Marques MEA. Paracoccidioidomycosis: frequency, morphology and pathogenesis of tegumentary lesions. An Bras Dermatol. 2007;82:411-7.

[3] 3 Shikanai-Yasuda MA, Conceição YMT, Kono A, Rivitti E, Campos AF, Campos SV. Neoplasia and paracoccidioidomycosis. Mycopathologia 2008;165:303-12.

[4] 4 Marques SA. Paracoccidioidomicose e esporotricose associada à imunossupressão. Med Cut Iber Lat Am. 2009;37:159-70.

[5] 5 Gutiérrez-Galhardo MC, Francisconi do Valle A, Fraga B, Schubach AO, Hoagland BR, Monteiro PC, et al. Disseminated sporotrichosis as a manifestation of immune reconstitution inflammatory syndrome. Mycoses. 2010;53:78-80.