Disseminated mycosis in a patient with yellow fever

Abstract

Disseminated mycosis (DM)—with cardiac involvement and shock—is an unexpected and severe opportunistic infection in patients with yellow fever. DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing. We report the case of a 53-year-old male patient who presented to the emergency department with fever, myalgia, headache, and low back pain. The laboratory investigation revealed a positive molecular test for yellow fever, hepatic injury, and renal failure. During hospitalization, the patient developed hepatic encephalopathy, ascending leukocytosis, and ascites, with signs consistent with peritonitis. On the 11th day of hospitalization, the patient developed atrioventricular block, shock and died. At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.

Kidney involvement in yellow fever: a review

“…In this third stage (intoxication phase), the hemorrhagic and hepatic dysfunctions of this disease occur, and other multiple organ dysfunctions may also come along. The intoxication stage is severe and accompanied by symptoms characteristic of YF disease, including jaundice (which gave it the name of “yellow fever”), vomiting (black vomit or dark vomit, other ancient names of the disease) and other hemorrhagic manifestations such as vascular leakage 8 , 27 , 36 .…”

“…Opportunistic diseases may also appear, and, according to Maciel et al . 36 , disseminated mycosis (severe infection in yellow fever patients) can mimic bacterial sepsis.…”

“…Maciel et al . 36 described in details the kidney lesions observed in the autopsy of patients affected by the severe form of yellow fever virus infection, which was associated to disseminated mycoses. In addition, according to the study by Maciel et al .…”

“…In addition, according to the study by Maciel et al . 36 , interstitial nephritis was identified, associated with tubular necrosis and interlobular thrombosis in kidney vessels, as well as hemorrhage and ischemic necrosis of the adrenal gland.…”

“…The suggestive zygomycotic finding was characterized as a typical fungal hypha (pauci-septated hyaline fungal hyphae with a lateral right-angle formation) in the intravascular and interstitial inflammatory foci. Moreover, multiple foci of hemorrhagic lesions and necrosis in the left adrenal gland were microscopically identified, while the right adrenal gland was normal 36 .…”