Paracoccidioides brasiliensis in a liquid‐based Papanicolaou test from a pregnant woman: Report of a case

Abstract

With the exception of Candida species, fungal organisms are rarely encountered in the Papanicolaou test and, when encountered, usually represent contaminants rather then infections. We present the case of a healthy 29-year-old pregnant female, gravida 1, para 0, who presented for her first prenatal visit at 12-week gestation and had many large fungal-like elements with a distinct budding pattern of multiple narrow-based buds resembling a "ship's-wheel" identified in her routine liquid-based Papanicolaou test. Based on its characteristic appearance in the Papanicolaou test and the hematoxylin and eosin, periodic acid Schiff and Gomori's methenamine silver stains performed on the cell block made from the residual sample, the fungus was diagnosed as "consistent with Paracoccidioides." This is the second reported case of Paracoccidioides presenting in a Papanicolaou test and shows that this organism may rarely involve the uterine cervix in the absence of clinical systemic disease.

Cytomorphology of unusual infectious entities in the Pap test

“…Mortality from coccidioidomycosis is rare, occurring in fewer than 1% of all infections. Although paracoccidioides in Pap tests has been reported in at least 2 previous publications,[1617] to the best of our knowledge, no coccidiomycosis cases have been reported in a Pap test. As in any other cytology preparation, coccidiomycosis in Pap test material shows large spherules [Figure 3].…”

“…[1317] Paracoccidioides have large fungal-like elements with a distinct budding pattern characterized by multiple narrow buds resembling a “ship-wheel.” Giant blastoconidia of C. albicans may have multiple buds that are more likely to resemble Paracoccidioides. Such giant forms of Candida may occur after antifungal therapy.…”

“…Such giant forms of Candida may occur after antifungal therapy. [17] Other organisms, including Rhinosporidium seerbi and Prototheca wickerhamii , may be morphologically confused with coccidioides species, but these are found in sites not typical of coccidioides; R. seerbi is found in nasal mucosal lesions, and P. wickerhamii is found in soft tissue sites. The endospores of coccidioides species may be confused with the spores of Histoplasma capsulatum .…”

Genitourinary paracoccidioidomycosis complicated with urinary outflow obstruction—a report of two cases and a review of the literature

“…It is almost exclusively a disease of men. Genitourinary PCM is extremely rare in females because feminine hormones presumably protect women of fertile age 1,10-12. Patients almost always present with multifocal disease, with lung infiltrates or other mucocutaneous lesions suggestive of PCM 2,3.…”

Epidemiology, Clinical, and Therapeutic Aspects of Paracoccidioidomycosis

“…Cases are mostly seen in men, since women are usually protected by feminine hormones [48]. In men, lesions can be present in the penis, scrotum, testicles, epididymis, and prostate [49,50].…”