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Anais Brasileiros de Dermatologia

Print version ISSN 0365-0596

An. Bras. Dermatol. vol.86 no.3 Rio de Janeiro May/June 2011

http://dx.doi.org/10.1590/S0365-05962011000300029 

IMAGES IN TROPICAL DERMATOLOGY

 

Paracoccidioidomycosis in a patient with cervical cancer*

 

 

Silvio Alencar MarquesI; Joel Carlos LastóriaII; Mariangela Esther Alencar MarquesIII

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. 1,2 Paracoccidioidomycosis 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. 3 Compared 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.         [ Links ]

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.         [ Links ]

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

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

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.         [ Links ]

 

 

Mailing address:
Silvio Alencar Marques
Rua Costa Leite, 515
18600-010 Botucatu-SP

Approved by the Editorial Board and accepted for publication on 05.05.2010.
Conflict of interest: None
Financial funding: None

 

 

* Study conducted at the Department of Dermatology and Radiotherapy, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil.