Paracoccidioidomycosis in a liver transplant recipient

Abstract

Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.

Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review

“…Nine cases of PCM in kidney transplant patients and a single episode in a liver transplant recipient fulfilled the inclusion criteria [51,52,53,54,55]. We excluded from the present series one episode of PCM mentioned in a report of a lung transplant recipient without any further details [56,57]. The patients had a median age of 55 years; three of them were rural workers before the transplantation, and three (60%) out of five cases with gender description were male.…”

“…One case of severe disseminated PCM in a 3-year-old girl was reported 24 months after liver transplantation due to congenital biliary atresia [56]. She was initially treated with cotrimoxazole (200/40 mg, q12h), and due to a poor clinical response, AMB was also prescribed.…”

New Insights on Pulmonary Paracoccidioidomycosis

“…35,[48][49][50] There are only 11 cases reported in solid organ transplantation, but as organ transplantation becomes more available in endemic areas of PCM, awareness of PCM pre-and posttransplant is important, as is investigation of PCM in cases of chronic granulomatous disease. [51][52][53][54][55][56][57][58] In the same way, the use of immunobiological therapy has been growing, and cases of PCM during its use have been reported. 59,60 Case series and isolated case reports suggest that cancer occurs in 0.6 to 11% of patients with PCM, mainly carcinomas of the respiratory and digestive tract, which share the same risk factors as PCM, that is, smoking and alcoholism.…”

Case Report: Paracoccidioidomycosis in Solid Organ Transplantation: Disseminated Disease in a Liver Recipient and Literature Review

“…[14][15][16][17][18][19][20][21][22] To date, 10 cases of PCM after SOT in adults and one case of PCM after hepatic transplantation in children have been described globally, including the present one (Table 1). [23][24][25][26][27][28][29][30][31] The 11th case of postrenal transplantation PCM was found in an autopsy review, as well as the single case of PCM after lung transplantation in a review of pulmonary infections, both without descriptive data, and therefore, not included in Table 1. 32 Among the 11 reported cases, only one occurred immediately posttransplantation, and all the others occurred late posttransplantation, as most commonly observed in endemic infections.…”

“…Uncommon severe clinical presentations are reported as isolated severe diarrhea leading to death and acute respiratory failure. 24,31 Amphotericin B was used in 50% of reported cases, possibly reflecting the potential severity of disseminated mycosis in immunocompromised recipients. In addition to the antifungal therapy, in some cases, immunosuppression was discontinued during treatment.…”