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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
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.
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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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