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Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease
Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-yea...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9870162/ https://www.ncbi.nlm.nih.gov/pubmed/36626374 http://dx.doi.org/10.1371/journal.pntd.0011023 |
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author | Marinho Falcão, Eduardo Mastrangelo da Costa Medeiros, Manuela Freitas, Andrea d´Ávila de Almeida Soares, João Carlos Fernandes Pimentel, Maria Inês Quintella, Leonardo Pereira Saraiva Freitas, Dayvison Francis de Macedo, Priscila Marques do Valle, Antônio Carlos Francesconi |
author_facet | Marinho Falcão, Eduardo Mastrangelo da Costa Medeiros, Manuela Freitas, Andrea d´Ávila de Almeida Soares, João Carlos Fernandes Pimentel, Maria Inês Quintella, Leonardo Pereira Saraiva Freitas, Dayvison Francis de Macedo, Priscila Marques do Valle, Antônio Carlos Francesconi |
author_sort | Marinho Falcão, Eduardo Mastrangelo |
collection | PubMed |
description | Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-year-old male, resident of Rio de Janeiro, presenting chronic diarrhea and abdominal pain in the past 3 years, previously diagnosed as Chron´s disease. When immunosuppressive therapy was prescribed, the patient evolved with worsening of the previous symptoms in addition to odynophagia, 20 kg-weight loss, disseminated skin lesions, diffuse lymphadenopathy and adrenal insufficiency. Histopathological and mycological examination of a skin lesion were compatible with PCM. Itraconazole was prescribed in high doses (400 mg/day). After seven months of treatment, the patient presented with acute abdominal pain which led to an emergent appendectomy, revealing the presence of the fungus. After 24 months, the patient reached clinical cure and recovered from adrenal insufficiency. We emphasize the importance of PCM as a differential diagnosis in patients with chronic diarrhea. The risk of fungal infections should be considered prior to initiating immunosupressive therapies, particularly in endemic areas. |
format | Online Article Text |
id | pubmed-9870162 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-98701622023-01-24 Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease Marinho Falcão, Eduardo Mastrangelo da Costa Medeiros, Manuela Freitas, Andrea d´Ávila de Almeida Soares, João Carlos Fernandes Pimentel, Maria Inês Quintella, Leonardo Pereira Saraiva Freitas, Dayvison Francis de Macedo, Priscila Marques do Valle, Antônio Carlos Francesconi PLoS Negl Trop Dis Research Article Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-year-old male, resident of Rio de Janeiro, presenting chronic diarrhea and abdominal pain in the past 3 years, previously diagnosed as Chron´s disease. When immunosuppressive therapy was prescribed, the patient evolved with worsening of the previous symptoms in addition to odynophagia, 20 kg-weight loss, disseminated skin lesions, diffuse lymphadenopathy and adrenal insufficiency. Histopathological and mycological examination of a skin lesion were compatible with PCM. Itraconazole was prescribed in high doses (400 mg/day). After seven months of treatment, the patient presented with acute abdominal pain which led to an emergent appendectomy, revealing the presence of the fungus. After 24 months, the patient reached clinical cure and recovered from adrenal insufficiency. We emphasize the importance of PCM as a differential diagnosis in patients with chronic diarrhea. The risk of fungal infections should be considered prior to initiating immunosupressive therapies, particularly in endemic areas. Public Library of Science 2023-01-10 /pmc/articles/PMC9870162/ /pubmed/36626374 http://dx.doi.org/10.1371/journal.pntd.0011023 Text en © 2023 Marinho Falcão et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Marinho Falcão, Eduardo Mastrangelo da Costa Medeiros, Manuela Freitas, Andrea d´Ávila de Almeida Soares, João Carlos Fernandes Pimentel, Maria Inês Quintella, Leonardo Pereira Saraiva Freitas, Dayvison Francis de Macedo, Priscila Marques do Valle, Antônio Carlos Francesconi Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title | Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title_full | Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title_fullStr | Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title_full_unstemmed | Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title_short | Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease |
title_sort | acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of crohn’s disease |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9870162/ https://www.ncbi.nlm.nih.gov/pubmed/36626374 http://dx.doi.org/10.1371/journal.pntd.0011023 |
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