The case of infectious. Paracoccidioidomycosis. Unusual presentation in a young patient

Abstract

An unusual case of paracoccidioidomycosis is presented. The patient, a 24 years-old male farmer, seeked medical attention due to the presence of an enlarging mass in the right testide. The mass was first noticed 16 months previously and for the last 8 weeks, weight loss and jaundice have also been noticed. A computarized axial tomography (CAT) and an abdominal echography revealed distal obstruction of the biliary system as well as the presence of retroperitoneal and inguinal nodules, pancreatic infiltration, hepatoesplenomegaly, and bilateral hydrocele. An exploratory laparotomy was performed and biopsies were taken from mesenteric nodules. Histopathological studies revealed the presence of abundant Paracoccidioides brasiliensis yeast ceIls, sorne of which exhibited multiple budding. Diagnosis of paracoccidioidomycosis was confirmed by serological methods. Treatment with itraconawle, 200 mg/day, was initiated and after 2 months, the patient has responded markedly. This case iIlustrates the polymorphism of paracoccidioidomycosis and stresses the need to consider the disease in differential diagnosis of pathologies, involving reticuloendothelial system.