Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Abstract

FIGURE 1 -Colonoscopy revealing the cecum and the ileocecal valve, a large ulcer, and an ulcer with fibrin (arrows). Revista da Sociedade Brasileira de Medicina Tropical 45(5):649-651, Sep-Oct, 2012Case Report ABSTRACT This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinal manifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.Keywords: Paracoccidioidomycosis. Psoas abscess. Paracoccidioides brasiliensis.fungal smear; normal renal and hepatic function panels; and negative microbiological stool tests. An abdominal and pelvic computed tomography (CT) demonstrated mesenteric lymphadenomegaly, with a hypodense center. Colonoscopy evidenced multiple deep ulcers with changeable sizes and forms along the whole colon, intercalated by normal mucosa, and a deformed ileocecal valve, which favored the diagnosis of infectious ulcerative pancolitis (Figure 1). Anatomopathological examination of the colonic mucosa revealed some areas of erosion covered in fibrino-leukocytic exudate, inflammatory infiltrate in corion, with some multinucleated giant cells, and lots of round shaped yeast, in various sizes, compatible with ileum-colonic PCM (Figure 2). A biopsy of a cervical lymph node also was performed, and in the anatomopathological examination, we found the Paracoccidioides brasiliensis, with non-caseating granulomas containing multinucleated giant cells and epithelioid histiocytes, presenting a steering wheel shape, compatible with PCM granulomatous lymphadenitis. During hospitalization, the patient was treated with venous sulfamethoxazole-trimethoprim (SMX-TMP) and amphotericin B (amphoB) deoxycholate, receiving a cumulative dose of 1,900mg after www.scielo.br/rsbmt 650 Duani H et al -Bilateral paracoccidioidomycotic iliopsoas abscess DISCUSSION 38 days. A complete regression of lymphadenopathy occurred, the patient gained weight, and the diarrhea ceased. After 40 days from admission, he was discharged, with a prescription of a daily use of SMX-TMP 800 + 160mg.The patient returned 40 days later, presenting recrudescence of the initial symptoms, including pain in the left hip, limited extension of the homolateral hip, limping, and fever. Furthermore, cultures were obtained, and an anatomopathological examination of an inguinal lymph node biopsied revealed Paracoccidioides brasiliensis. He was rehospitalized and treated with amphoB plus oral itraconazole and sulphadiazine.Abdominal and pelvic CT showed mesenteric lymphadenomegaly, enlargement of the left iliac and psoas muscles, with inner voluminous liquefaction, which extended from the level of the third lumbar vertebra (L3) to the pelvis. Moreover, a smaller collection was observed in the right psoas muscle at...

Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

“…The signs and symptoms presented by the majority of the patients from this cohort were related to the reticuloendothelial system, corresponding to the findings of other authors . Disseminated lethal cases affecting unusual organs and tissues with no clinical evidence were also observed in this study, confirming that the yeasts are capable to invade every tissue of the human body …”

“…Albumin levels significantly increased the area under the curve lethal cases affecting unusual organs and tissues with no clinical evidence were also observed in this study, confirming that the yeasts are capable to invade every tissue of the human body. [17][18][19][20][21][22][23][27][28][29][30][31] The extent of the elapsed time since the appearance of the first symptoms of PCM until the admission in a specialised centre did not interfere in the development of complications of the disease.…”

Percutaneous drainage of iliopsoas abscess: an effective option in cases not suitable for surgery

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Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

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