The case of infectious. Paracoccidioidomycosis and tuberculosis

Abstract

The simultaneous presence of pulmonary paracoccidioidomycosis and tuberculosis in an adult male is reported. The initial clinical diagnosis was tuberculosis but direct examination of AFB were negative; on the other hand, P. brasiliensis cells were readily observed in sputum samples. Cultures turned out positive for both P. brasiliensis and M. tuberculosis. Dual therapy (ketoconazole for the rnycoses, ethambutol and isoniacid for tuberculosis) brought gradual and marked improvement of the patient's condition. Serological monitoring of fungal antibodies proved useful in the follow-up observations. The radiological appearance of the lungs showed abundant, bilateral infiltrates which receded during the course of therapy. Fibrosis and bullae remained as permanent sequelae. The need to employ various laboratory tests to establish the proper diagnosis of patients like the one presented, is stressed.