CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS
SUMMARY A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prer...
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ftdoajarticles:oai:doaj.org/article:8599e927a07248bb8f779c7101ef35b1 2024-09-09T19:26:45+00:00 CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS Flávia Fonseca FERNANDES Victor Oliveira ALVES Tarquino Erastides Gavilanes SÁNCHEZ Wagner Diniz de PAULA Alfredo Nicodemos Cruz SANTANA 2016-01-01T00:00:00Z https://doi.org/10.1590/S1678-9946201658057 https://doaj.org/article/8599e927a07248bb8f779c7101ef35b1 EN eng Universidade de São Paulo (USP) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652016005000407&lng=en&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/S1678-9946201658057 https://doaj.org/article/8599e927a07248bb8f779c7101ef35b1 Revista do Instituto de Medicina Tropical de São Paulo, Vol 58, Iss 0 (2016) Paracoccidioidomycosis Breast neoplasms Breast Chylothorax Chylous ascites Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2016 ftdoajarticles https://doi.org/10.1590/S1678-9946201658057 2024-08-05T17:49:30Z SUMMARY A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Revista do Instituto de Medicina Tropical de São Paulo 58 0 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Paracoccidioidomycosis Breast neoplasms Breast Chylothorax Chylous ascites Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Paracoccidioidomycosis Breast neoplasms Breast Chylothorax Chylous ascites Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Flávia Fonseca FERNANDES Victor Oliveira ALVES Tarquino Erastides Gavilanes SÁNCHEZ Wagner Diniz de PAULA Alfredo Nicodemos Cruz SANTANA CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
topic_facet |
Paracoccidioidomycosis Breast neoplasms Breast Chylothorax Chylous ascites Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
SUMMARY A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions. |
format |
Article in Journal/Newspaper |
author |
Flávia Fonseca FERNANDES Victor Oliveira ALVES Tarquino Erastides Gavilanes SÁNCHEZ Wagner Diniz de PAULA Alfredo Nicodemos Cruz SANTANA |
author_facet |
Flávia Fonseca FERNANDES Victor Oliveira ALVES Tarquino Erastides Gavilanes SÁNCHEZ Wagner Diniz de PAULA Alfredo Nicodemos Cruz SANTANA |
author_sort |
Flávia Fonseca FERNANDES |
title |
CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
title_short |
CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
title_full |
CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
title_fullStr |
CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
title_full_unstemmed |
CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS |
title_sort |
chylothorax in paracoccidioidomycosis |
publisher |
Universidade de São Paulo (USP) |
publishDate |
2016 |
url |
https://doi.org/10.1590/S1678-9946201658057 https://doaj.org/article/8599e927a07248bb8f779c7101ef35b1 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista do Instituto de Medicina Tropical de São Paulo, Vol 58, Iss 0 (2016) |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652016005000407&lng=en&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/S1678-9946201658057 https://doaj.org/article/8599e927a07248bb8f779c7101ef35b1 |
op_doi |
https://doi.org/10.1590/S1678-9946201658057 |
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Revista do Instituto de Medicina Tropical de São Paulo |
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58 |
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