Unusual Intestinal Involvement by Paracoccidioidomycosis Diagnosed After Oral Manifestation

Intestinal Paracoccidioidomycosis: Case report and systematic review

Background

Paracoccidioidomycosis is a systemic mycosis considered endemic and limited to Latin America with the majority of registered cases originating from Brazil. The purpose of this paper was to report a case of a female patient with paracoccidioidomycosis mimicking inflammatory bowel disease and to systematically review available cases of the intestinal presentation of this infectious disease.

Case report

Female patient, 32-years old, previously asymptomatic, presenting with acute pain in the lower right abdomen, associated with signs of peritoneal irritation and abdominal distension. Urgent surgery was performed, which identified a severe suppurative perforated ileitis. The anatomopathological study revealed fungal structures shaped as a ship's pilot wheel in Grocott-Gomori's staining, suggestive of Paracoccidioides spp.

Methods

Studies were retrieved based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Languages were restricted to English, Spanish and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually. Simple descriptive analysis was used to summarize the results.

Results

Our search strategy retrieved 581 references. In the final analysis, 34 references were included, with a total of 46 case reports. The most common clinical finding was abdominal pain and weight loss present in 31 (67.3%) patients. Most patients were treated with itraconazole (41.3%) and amphotericin B (36.9%). All-cause mortality was 12.8%.

Conclusions

Paracoccidioidomycosis should be suspected in endemics areas, specially as a differential diagnosis for inflammatory bowel disease. Endoscopic tests and biopsy are useful for diagnosis and treatment with antifungal drugs seem to be the first treatment option to achieve a significant success rate.

Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases

Paracocciodiomycosis (PCDM) is a chronic systemic fungal infection, mainly affecting residents and rural workers, being characterized by a long incubation period, which it can take months or years without clinical manifestations, making diagnosis late and difficult. Depending on the stage of the disease, it can cause sequelae and low quality of life, so its correct diagnosis is of great importance for the accurate treatment. Therefore, the aim of this report is to present two cases of diagnosis of patients with PCDM at different stages, who developed chronic manifestations, pain, clinical involvement of the oral cavity and in one case also presented lung injury with fibrosis, as well as to weight loss, dysphagia and cachexia. Both of patients were treated with antifungal therapy and it was observed total remission of the lesions and no recurrences were detected.

Oral paracoccidioidomycosis in a non-endemic region from Brazil: A short case series

Background

Although the paracoccidioidomycosis (PCM) is endemic in Brazil, the occurrence in most states from the North and Northeastern Brazil is very unusual. The aim of this study was to evaluate the clinicopathologic features of a case series of oral PCM in a non-endemic region from Brazil (Northeastern region), discussing the clinical and histopathological differential diagnoses of the oral manifestations of the disease.

Material and Methods

Between 2000 and 2017, all cases of oral PCM were retrieved from the Oral Pathology Laboratory, Universidade Federal de Pernambuco, located at Northeastern Brazil. Clinical data, such as age, gender, origin, occupation, site, symptoms, time of complaints, clinical presentation, number of lesions, and clinical hypotheses of diagnosis, were collected from the clinical charts. All cases were histologically reviewed in hematoxylin-eosin and Gomori-Grocott staining.

Results

Six cases were identified. All patients were male, with a mean age of 53.8 years (ranging from 40 to 73 years). Four cases appeared as multiple ulcers and two presented single lesions (buccal mucosa and hard palate). Clinically, in five cases, squamous cell carcinoma was considered in the differential diagnosis. The common histopathological features consisted of hyperplastic epithelium, intraepithelial microabscesses, and formation of granulomatous chronic inflammatory reaction in a fibrous connective tissue with severe chronic inflammatory reaction. Yeasts were observed either inside of multinucleated giant cells or extracellularly.

Conclusions

Although rare in non-endemic regions, oral PCM should be considered in the differential diagnosis of oral chronic ulcers, mainly those multiple.

Key words:Oral mucosa, mycology, paracoccidoidomycosis, ulcer.