Paracoccidioidomycosis due to Paracoccidioides lutzii complicated with adrenal injury and pulmonary arterial hypertension

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Gilberto Gambero Gaspar, Tiago Alexandre Cocio, Fernanda Guioti-Puga, Erika Nascimento, Alexandre Todorovic Fabro, Marcia Regina von Zeska Kress, Eduardo Bagagli, Roberto Martinez
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2020
• Subjects: Paracoccidioidomycosis; Paracoccidioides lutzii; Pulmonary arterial hypertension; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/s1678-9946202062089; https://doaj.org/article/484481c3e3674233923a4b1bd27499a6

ABSTRACT Paracoccidioidomycosis caused by Paracoccidioides lutzii is endemic in the Midwest of Brazil and its clinical spectrum is still little known due to the recent identification of this fungal species. A patient resident in Southeast Brazil, but who had lived for many years in the Midwest region, presented with skin injuries, chronic cough and bilateral adrenal involvement. Paracoccidioides spp. was isolated in culture from a skin lesion biopsy. This isolate was later identified as P. lutzii using gene sequencing. A favorable initial response to treatment with itraconazole was observed, but a few weeks later, the patient developed respiratory failure and worsening of lung lesions. Evaluation by computed tomography and echocardiography were suggestive of pulmonary arterial hypertension, and a bronchoscopic biopsy showed peribronchial remodeling. The patient completed the antifungal treatment but maintained the respiratory dysfunction. The reported case shows that P. lutzii can be isolated from patients in a geographic area far from the place of infection acquisition and that, as P. brasiliensis , it can cause adrenal injury and cardio-respiratory complications as a consequence of excessive necrosis and fibrosis.