Abstracts
Paracoccidioidomycosis is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis that is characterized by polymorphous clinical manifestations principally affecting the skin, mucous membranes, lungs, lymph nodes, adrenal glands and the central nervous system. Depending on the site of inoculation and the individual's immunological status, the disease may take various different forms, affecting the skin, lymph nodes, viscera or a combination of these. The present report describes a patient with extensive cutaneous and pulmonary paracoccidioidomycosis, with disseminated papules and pustules, fever and pulmonary symptoms, probably related to immunosuppression caused by a renal carcinoma.
Carcinoma; Immunocompromised host; Kidney neoplasms; Paracoccidioidomycosis
Paracoccidioidomicose é doença causada pelo fungo Paracoccidioides brasiliensis, caracterizada por quadro polimórfico e acometimento preferencial de pele, mucosas, pulmões, linfonodos, adrenais e sistema nervoso. De acordo com o local de inoculação e o estado imunológico do indivíduo, ocorrem as diversas formas da doença: tegumentar, linfonodular, visceral e mista. Relatamos caso de paciente com quadro de paracoccidioidomicose mista (tegumentar e pulmonar), com lesões cutâneas caracterizadas por pápulas e pústulas disseminadas e sintomas sistêmicos, possivelmente associada a imunossupressão causada por neoplasia maligna visceral.
Carcinoma; Hospedeiro imunocomprometido; Neoplasias renais; Paracoccidioidomicose
IMAGENS EM DERMATOLOGIA TROPICAL
Cutaneous and pulmonary paracoccidioidomycosis in a patient with a malignant visceral tumor*Adriana Maria PorroI; Osmar RottaII
IPhD. Adjunct Professor, Department of Dermatology, São Paulo School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
IIPhD. Associate Professor and Head, Department of Dermatology, São Paulo School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
Mailing address
ABSTRACT
Paracoccidioidomycosis is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis that is characterized by polymorphous clinical manifestations principally affecting the skin, mucous membranes, lungs, lymph nodes, adrenal glands and the central nervous system. Depending on the site of inoculation and the individual's immunological status, the disease may take various different forms, affecting the skin, lymph nodes, viscera or a combination of these. The present report describes a patient with extensive cutaneous and pulmonary paracoccidioidomycosis, with disseminated papules and pustules, fever and pulmonary symptoms, probably related to immunosuppression caused by a renal carcinoma.
Keywords: Carcinoma; Immunocompromised host; Kidney neoplasms; Paracoccidioidomycosis
A 68-year old man presented with acute fever, a dry cough and disseminated papules and pustules (Figures 1 and 2). Direct examination of the skin lesion: round-shaped, multi-budding, birefringent walled yeasts. Histopathology of the skin: Suppurative granuloma, round-shaped structures compatible with Paracoccidioides sp (Figures 3 and 4). Positive serology (1:4 dilution) for Paracoccidioides (immunodiffusion - antigen gp43). Chest x-ray: Perihilar infiltrates. Computed tomography of the abdomen: Image suggestive of renal carcinoma. Treatment was initiated with itraconazole 400 mg/day and both the patient's general state of health and his skin lesions improved. Resection of the renal carcinoma was performed (multilocular cystic renal cell carcinoma, a variant of clear cell renal cell carcinoma). This exuberant and atypical manifestation that resulted in the inclusion of numerous differential diagnoses emphasizes the importance of direct examination, a simple and inexpensive tool, for confirmation of diagnosis. The clinical behavior of this deep mycosis as an opportunistic disease should also be emphasized, this finding also being present in patients who are immunocompromised due to other causes such as organ transplantation or human immunodeficiency virus (HIV) infection. 1-6
REFERENCES
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Publication Dates
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Publication in this collection
23 Jan 2012 -
Date of issue
Dec 2011
History
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Accepted
21 Sept 2010 -
Received
28 Mar 2010
