Intestinal paracoccidioidomycosis resembling Crohn’s disease in a teenager: a case report

Abstract

BackgroundDifferential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn’s disease.Case presentationWe report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn’s disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome.ConclusionParacoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.

Avanços e desafios no diagnóstico de paracoccidioidomicose causada pelo complexo de espécies da paracoccidioides: revisão integrativa

“…A paracoccidioidomicose é uma doença fúngica que pode assemelhar-se às manifestações da doença de Crohn em pacientes de países endêmicos, uma vez que esta condição auto inflamatória crônica pode afetar qualquer parte do trato digestivo. Sendo assim, os pesquisadores sugerem que a PCM intestinal deve ser considerada como um diagnóstico diferencial para doença inflamatória intestinal em áreas endêmicas (Lomazi, et al, 2018). Research, Society and Development, v. 11, n. 3, e13911326152, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i3.26152 Buccheri, et al, (2018) demonstraram um relato de caso em que o paciente foi diagnosticado com a forma aguda (FA) da P. brasiliensis, porém 21 dias do início do tratamento o paciente fez uma triagem de rotina que acabou tendo resultados inconclusivos para P. brasiliensis anticorpos, entretanto teve resultados positivos com P. lutzii antígenos.…”

Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn’s disease

“…PCM mimicking CD has been scarcely reported in the literature and in most reported cases the diagnosis came after several months of symptoms [5][6][7][8]. The wrong diagnosis led to immunosuppressive therapy leading to worsening of symptoms in some cases [6][7][8].…”

“…PCM mimicking CD has been scarcely reported in the literature and in most reported cases the diagnosis came after several months of symptoms [5][6][7][8]. The wrong diagnosis led to immunosuppressive therapy leading to worsening of symptoms in some cases [6][7][8]. A recently published systematic review found 46 cases of gastrointestinal PCM predominantly in young men presenting the acute PCM form.…”

“…The colonoscopy findings of PCM may include ulcers clinically similar to CD [6][7][8] and the histopathological study of these lesions may be unspecific or difficult to differentiate if yeastlike fungal structures of Paracoccidioides spp. are not visualized since granulomatous inflammation can be observed in both diseases [5,9].…”

Intestinal Paracoccidioidomycosis: Case report and systematic review

“… 7 For this reason, PCM should be considered in the differential diagnosis of inflammatory bowel diseases, specially in endemic countries, such as Brazil. 8 …”