Paracoccidioidomycosis in Patients with Lymphoma and Review of Published Literature

Abstract

This paper describes four new cases of lymphomas, two Hodgkin lymphomas and two non-Hodgkin lymphomas in patients with paracoccidioidomycosis. All had mycosis diagnosed before lymphomas with Paracoccidioides brasiliensis demonstrated in several lymph nodes, as seen in the disseminated form of the disease. When lymphoma was diagnosed, one patient was under regular paracoccidioidomycosis treatment and in clinic-serological remission for this disease, another was under regular treatment but with clinic-serological mycosis activity, one had abandoned paracoccidioidomycosis treatment 6 years earlier, and the other had not yet received any kind of antifungal drugs. Three patients received treatment for lymphomas with one remaining in remission until now, one achieving tumor remission which relapsed years later, and one having only residual lymphoma in bone marrow for a decade but clinically well. All three experienced paracoccidioidomycosis clinical remission, however, serology became negative just in one. Similar previously described cases were reviewed: five Hodgkin lymphomas, three non-Hodgkin lymphomas, and one described only as "lymphoma" without specifying type; a summary of their findings is presented. Finally, there is also a brief discussion on the possible pathophysiological mechanisms involved in the concomitance of these two disorders.

Brazilian guidelines for the clinical management of paracoccidioidomycosis

“…Diagnostic suspicion is fundamental for early diagnosis and treatment because clinical manifestations of cancer in patients with PCM can be masked by symptoms resulting from sequelae of fungal lesions in the lungs, larynx, or pharynx, especially in smokers and alcoholics. Less frequently, PCM manifests simultaneously or reoccurs with neoplasias, such as lymphoma, leukemia, and pulmonary carcinoma 19,70 . This PCM is probably opportunistic and presents with localized lesions, particularly in the lung or disseminated.…”

Paracoccidioidomycosis: Current Perspectives from Brazil

“…Studies on the association between PCM and malignant tumours are relatively scarce. Carcinomas are the most frequently diagnosed type of neoplasia in PCM patients, that has been attributed to the humoral and cellular immune dysregulation induced by P. brasiliensis [ 314 ]. On the other hand, the immunesupression caused by some neoplasias and/or their treatments could reactivate quiescent P. brasiliensis foci.…”

“…On the other hand, the immunesupression caused by some neoplasias and/or their treatments could reactivate quiescent P. brasiliensis foci. Although the co-morbidity PCM-lymphoma is rare, with cases showing PCM previously to lymphoma, it is possible to suggest that the chronic stimulation by paracoccidioidal antigen could be implicated in the origen of B lymphomas [ 314 ]. Additional studies should be performed to better understand this subject.…”

II Consenso Brasileiro em Paracoccidioidomicose - 2017*

“…Com menor frequência, a doença por Paracoccidioides spp manifesta-se depois de (ou simultaneamente a) neoplasias, como linfoma, leucemia e carcinoma pulmonar, inclusive como recidiva da micose. 19,70 Esta PCM provavelmente é oportunista e apresenta-se com lesões localizadas, particularmente no pulmão ou disseminadas. Em geral, a doença é controlada com terapia antifúngica, e os óbitos são atribuídos à neoplasia.…”