Alves R, Marote J, Armas M, Freitas C, Almeida LS, Sequeira H, Gómes MA, Verissimo C, Rosado ML, Faria A

Language: Portugués
References: 12
Page: 63-66
PDF size: 279.96 Kb.

ABSTRACT

We report a case of a 43 years-old portuguese man, natural and resident in Madeira island, who was emigrated in Venezuela until 6 years ago. He was observed on March 2008 for a crusted papulo-nodular lesion with erythematous regular borders, pruritic and sized 4,5 x 3,0 cm, located on the dorsum, with a 2 month history. There was no palpable lymphadenopathy. He denied other simptomatology. On March of 1999, the patient had a mouth lesion which was compatible with paracoccidioidomycosis on histopathological examination. He was not aware of any associated pathologies. We performed two punch biopsies of the cutaneous lesion for histopathological and mycological examination.
The histopathology showed the presence of multiple round cells of different size (yeast cells) in a narrow base suggesting the classic “pilot’s wheels”, on Hematoxiline & Eosine stain. On direct microscopic examination the mycology revealed yeast of different sizes – some of them on gemulation. The cultures, at 24º and 37º, isolated Paracoccidioides brasiliensis.
The thoracic x-ray revealed a heterogeneous, bilateral and symmetric pattern located towards the central and basal portions. The CT scan of the chest showed multiple, micronodular and striated lesions (some of them with small cavities), with tendency to coalesce. To characterize better these lung abnormalities, the patient performed a fibrobronchoscopy of the respiratory tract which was normal. The culture, at 25 ºC, obtained from the sputum of the bronchoalveolar lavage fluid (BAL) showed Paracoccidioides brasiliensis.
Routine laboratory studies were normal and serology negative for HIV and tuberculosis. The treatment of choice was itraconazol 200 mg/day, for 6 months. As far as we know no case of PCM has been reported in Madeira. Although it is not a frequent disease outside the endemic areas, dermatologists should be able to recognise and diagnose systemic mycosis like PCM.

REFERENCES

1. Marques, SA, Camargo, Rosângela MM, Mariangela EA. Caso para diagnóstico. An Bras Dermatol 2007, 82: 579-81.

2. Marques SA. Cutaneous lesions. In: Franco M, Lacaz CS, Restrepo-Moreno, Del Negro G. editors. Paracoccidioidomycosis. Boca Raton: CRC Press; 1994, pp. 259-66.

3. Shikanai-Yasuda MA, Telles Filho FQ, Mendes RP, Colombo AL, Moretti ML. Consenso em paracoccidioidomicose. Rev Soc Bras Med Trop 2006; 39: 297-310.

4. Mayayo E, López-Aracil V, Fernández-Torres B, Mayayo R, Domínguez M. Report of an imported cutaneous disseminated case of paracoccidioidomycosis. Rev Ibero Am Micol 2007; 24: 44-6.

5. Palmeiro M, Cherunini K, Yurgel L. Paracoccidioidomicose – Revisão da Literatura Medica, Porto Alegre, PUCRS 2005, vol 15, (4) out./dez.

6. Marques, AS. Paracoccidioidomicose: atualização epidemiológica, clínica e terapêutica. An Bras Dermatol 2003;78:135-50

7. Castro RM, Cucé LC, Fava-Netto C. Paracoccidioidomicose: Inoculação acidental “in animanobile”. Relato de um caso. Med Cutan Ibero Lat Amer 1975; 4: 289-92.

8. Shikanai-Yasuda MA, Higaki Y, Del Negro GB, HO Joo S, Vaccari ME, Benard G et al. Randomized therapeutic trial with itraconazole, ketoconazole and sulfadiazine in paracoccidioidomycosis. Medical Mycol 2002; 40: 411-7.

9. García Bustinduy M, Guimera F, Arévalo P, Castro C, Saez M, Dorta Alom S et al. Cutaneous primary paracoccidioidomycosis. J Eur Acad Dermatol Venerol 2000; 14: 113- 17.

10. Horré R, Schumacher G, Alpers K, Seitz HM, Adlers S, Lemmer K et al. A case of imported paracoccidioidomycosis in a German legionnaire. Med Mycol 2002; 40: 213-6.

11. Mayr A, Kirchmair M, Rainer J, Rossi R, Kreczy A, Tintelnot K, Dierich MP, Lass-Florl C. Chronic paracoccidioidomycosis in a female in Austria. Eur J Clin Microbiol Infect Dis 2004; 23: 916-9.

12. Van Damme PHA, Bierenbroodspot F, Telgt DCS, Kwakman JM, De Wilde PCM, Meis JFGM. A case of imported paracoccidioidiomycosis: an awkward infection in The Netherlands. Med Mycol 2006; 44: 13-8.