Paracoccidioidomycosis: Endobronchial Involvement in a Rare Disease in Europe

Sousa, Cláudia; Alves, José; Cordeiro, Michelle

http://hdl.handle.net/10400.26/35891

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Authors

Sousa, Cláudia

Alves, José

Cordeiro, Michelle

Abstract(s)

We report the case of a 64 years old man, a former farmer inVenezuela, with heavy alcoholic and tobacco smoking habits withno immunosuppressive status.As he presented hemoptoic sputum, a computed tomographicstudy was performed, showing multiple calcifications, fibro-cicatricial lesions scattered in both lungs, along with emphysema and bronchiectasis. Bronchofibroscopy documented an exuberantinflammatory process, with nacreous plaques, hemorrhagic areasand ulceration of the lower third of tracheal mucosa and bothbronchial trees. Histology of bronchial biopsies revealed a necrotiz-ing granulomatous inflammatory process with polymorphonuclearcells and macrophages. Histochemical study revealed the presenceof fungus in Grocott and PAS coloration stains (Fig. 1). No mycobac-teria or neoplastic cells were detected.A second bronchofibroscopy was executed to collect samples tomycological evaluation in a National Center, were PCR for detectionof fungal DNA identified the fungus Paracoccidioides brasiliensis.Paracoccidioidomycosis is endemic in South America, mainlyBrazil (80%), Argentina, Colombia and Venezuela1,2. Although pul-monary involvement is frequent, endobronchial lesions solelyrarely have been described2and in this case were initially misinter-preted as suggestive of neoplasm, what was excluded in histologicalstudies. This patient presented clinical, imagiological and endo-scopic improvement after treatment with itraconazole 200 mg foreighteen months.