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Paracoccidioidomicose: caso clínico

2018Journal article Open access
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dc.contributor.authorAlves, Rubina
dc.contributor.authorArmas, Mónica
dc.contributor.authorSoares-de-Almeida, Luís
dc.contributor.authorVerissimo, Cristina
dc.contributor.authorFreitas, C
dc.contributor.authorSequeira, H
dc.contributor.authorGomes, MA
dc.contributor.authorVerissimo, C
dc.contributor.authorRosado, ML
dc.contributor.authorFaria, A
dc.date.accessioned2020-01-23T12:44:48Z
dc.date.available2020-01-23T12:44:48Z
dc.date.issued2018
dc.description.abstractOs autores reportam o caso clínico de um homem, 43 anos de idade, natural e residente na ilha da Madeira, emigrado na Venezuela até há 6 anos. Em Março 2009, observado por aparecimento de lesão pápulo-crostosa de bordos regulares eritematosos, indolor, pruriginosa, com dimensões de 4,5 x 3 cm, localizada no dorso, com 2 meses de evolução. Como antecedentes, refere história de lesão da mucosa bucal, com exame histopatológico compatível com paracoccidioidomicose (PCM). Foram efectuadas duas biópsias da lesão cutânea para avaliação histopatológica e micológica. O exame histopatológico revelou a presença de múltiplas células circulares, sugerindo distribuição característica de “roda de leme”. O estudo micológicos revelou, no exame directo, a presença de leveduras – algumas em gemulação. As culturas permitiram isolar o Paracoccidioides brasiliensis. A radiografia pulmonar apresentava infiltrado bilateral e simétrico, nos lobos centrais e basais. A Tomografia Axial Computadorizada torácica demonstrou múltiplos nódulos espiculados, áreas de opacidade e bronquiectasias. Foi efectuada broncofibroscopia (sem alterações) e simultaneamente foi obtido o lavado broncoalveolar (LBA). A cultura, a 25º C, revelou a presença de hifas e clamidósporos (forma filamentosa). Na cultura, a 37º C, não se obteve a forma leveduriforme. O tratamento efectuado foi o itraconazol 200 mg/dia, durante 6 meses, com regressão da lesão. Até à actualidade, nenhum caso de PCM foi reportado na ilha da Madeira, Portugal. Embora não seja frequente, fora das áreas endémicas, os dermatologistas devem ser capazes de reconhecer e diagnosticar micoses sistémicas, como a PCM.pt_PT
dc.description.abstractWe 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationMed Cutan Iber Lat Am 2013;41(2):63-66pt_PT
dc.identifier.doi10.4464/MC.2013.41.2.5059pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/31093
dc.language.isoporpt_PT
dc.relation.publisherversionhttps://www.researchgate.net/publication/267510868pt_PT
dc.subjectmicose profundapt_PT
dc.subjectparacoccidioidomicosept_PT
dc.subjectparacoccidoides brasiliensispt_PT
dc.subjectIlha da Madeirapt_PT
dc.subjectMadeira Islandpt_PT
dc.subjectPortugalpt_PT
dc.titleParacoccidioidomicose: caso clínicopt_PT
dc.title.alternativeParacoccidioidiomycosis: case reportpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage66pt_PT
oaire.citation.startPage63pt_PT
person.familyNameAlves
person.familyNameArmas
person.givenNameRubina
person.givenNameMónica
person.identifier.orcid0000-0002-9542-8020
person.identifier.orcid0000-0002-6096-5619
person.identifier.ridK-3585-2013
person.identifier.scopus-author-id30867491800
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication031d2ac5-7a3e-468f-8481-d06f68092e0d
relation.isAuthorOfPublicationba88a93f-c561-469e-81ed-cbd4716fd695
relation.isAuthorOfPublication.latestForDiscoveryba88a93f-c561-469e-81ed-cbd4716fd695

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