Paracoccidioidomicose da região ocular: relato de dois casos e revisão da literatura

Abstract

No Brasil, a paracoccidioidomicose é doença endêmica que pode afetar diversos órgãos, sendo pouco comum o envolvimento da região ocular. Nessa forma, é freqüente o acometimento de conjuntivas e pálpebras, configurando-se em afecção importante a considerar no diagnóstico diferencial das lesões da região orbitária. Mesmo nas formas localizadas deve ser feita a avaliação sistêmica, uma vez que a ocorrência da paracoccidioidomicose na região ocular pode ser parte de doença multifocal. Relatam-se dois casos de paracoccidioidomicose da região ocular e faz-se uma revisão dos 55 casos descritos na literatura até o momento.

Paracoccidioidomicose sistêmica multifocal: desafio diagnóstico por manifestação cutânea tardia

“…Ocular involvement is rare, affecting mainly eyelids and conjunctiva. 2 Gastrointestinal and genitourinary tracts, nervous system and suprarenals can be occasionally affected specially in severe cases 7,9 , as our patient, who presented nephritic proteinuria, that was the reason for his hospitalization…”

“…2,5 It presents acute, subacute or chronic evolution that can affect one (unifocal) or more organs (multifocal). 5,6 In this case the profession, origin and the chronicity of the condition were relevant aspects in clinical suspicion of this mycosis.…”

“…The effective drugs against PCM comprise three groups: amphotericin B, sulfadiazine, and other sulfonamides compounds and azoles with systemic action. 2,7,9 Classic amphotericin B a is drug of choice in the serious or multifocal cases. 8 Its choice was made possible by hospital apparatus, which allowed quick clinical remission of the serious and lagged condition of this case.…”

“…1,2,3 It was originally described in Brazil, by Adolfo Lutz, in 1908. 2,3 It is endemic in the country predominantly in the south, south-east and midwest regions of Brazil. 3,4 The main source of infection is inhalational and the pulmonary complex can be eliminated becoming a quiescent focus or progressing to internal organs.…”