Disseminated paracoccidioidomycosis with skull and mandible involvement in a heart transplant recipient

When the adrenals alert us to a systemic fungal disease

“…The ability of the female hormone oestrogen to bind to Paracoccidioides and inhibit its transformation from mycelial to yeast forms may constitute an essential protective mechanism for women. 5,6 Multiple pathogens may infect the adrenal, including P. brasiliensis and other fungi, and this can be attributed to immunosuppression related to high steroid concentrations. 7 Paracoccidioides brasiliensis has a tropism for adrenal glands, as in 90% of the autopsy cases, we observe these fungi.…”

“…Inhaled conidia (mycelial phase) converts to the yeast form, which is taken up by tissue‐resident macrophages. The ability of the female hormone oestrogen to bind to Paracoccidioides and inhibit its transformation from mycelial to yeast forms may constitute an essential protective mechanism for women 5,6 …”

Systematic review of neuroparacoccidioidomycosis: The contribution of neuroimaging

“…A small percentage occurs in immunocompromised patients, which in the vast majority has been reported in HIV patients 45 . Previous case reports of PCM in transplant recipients have been described, mainly in kidney transplants 46,47 . The association of NPCM and HIV is also rare, 42 which can occur in any stage of HIV infection; it is not necessarily associated with immunosuppression.…”

“…45 Previous case reports of PCM in transplant recipients have been described, mainly in kidney transplants. 46,47 The association of NPCM and HIV is also rare, 42 which can occur in any stage of HIV infection; it is not necessarily associated with immunosuppression. The clinical course of PCM in HIV patients resembles an acute/subacute infection and disseminated.…”