Protein-losing enteropathy in paracoccidioidomycosis identified by scintigraphy: report of three cases

Abstract

Paracoccidioidomycosis (PCM) or South American Blastomycosis is a systemic fungal infection caused by a dimorphic fungus, Paracoccidioides brasiliensis. It represents the most important systemic mycosis in South America and with higher prevalence among male inhabitants of the rural area. PCM usually affects the lungs, and rarely the intestines. The authors report three cases of PCM, treated at the University Hospital of Universidade Federal de Mato Grosso do Sul whose scintigraphy with technetium-99 labeled human albumin revead intestinal protein loss.

Protein-Losing Enteropathies

“…In addition, they include isolated instances of PLE due to Epstein Barr virus and rotovirus infection (Veres et al, 2004;Iwasa and Matsubayashi, 2008), as well as infection with a variety of parasitic organisms (Sullivan et al, 1992), most notably that due to giardia lamblia with and without immunodeficiency (Furtado et al,2012;Dubey et al, 2000). Finally, they include a number of fungal organisms such as infection with paracoccidioidomycosis and histoplasma (Berni et al, 2010;Kok et al, 2010). In general, it is unclear when these infections result in PLE, although this may relate either to the severity and extent of infection or to isolated effects on lymphatic drainage.…”

Unusual Intestinal Involvement by Paracoccidioidomycosis Diagnosed After Oral Manifestation

“…Paracoccidioidomycosis (PCM) is an endemically fungal infection in Latin America, with higher prevalence in Brazil. It is caused by dimorphic fungi of the genus Paracoccidioides, and the human infection was first described in 1908 by Adolph Lutz [1][2][3][4][5][6][7][8]. Geographic areas of highest incidence are typically humid, high-rainfall areas with acidic soil conditions.…”

“…Geographic areas of highest incidence are typically humid, high-rainfall areas with acidic soil conditions. The organisms are present in the soil and enter the body mainly through the aerodigestive tract, especially through the lungs [5,9,10]. At room temperature, it has a mycelium form that transforms into yeast-like form, the pathogenic form, at 35-37°C [8].…”

“…When the PCM affects the intestine, all segments can be involved, but predominantly affects the jejunum, terminal ileum, appendix, and proximal portion of the large intestine. Mesenteric ganglion infarction with lymphatic stasis and lymph reflux toward the intestinal lumen was observed in the small and large intestine, leading to an exudative enteropathy [5,13,14]. The hematogenic spread is the main form which PCM reaches any organ, include the intestine, but ingestion may be considered [15].…”

“…In PCM, polymorphic manifestations are frequently observed, which impairs the establishment of a diagnosis. Thus, PCM is not always suspected and sometimes patients can be misdiagnosed, mainly in cases of females and younger individuals [1,4,5,[16][17][18][19].…”