Disseminated paracoccidioidomycosis under biological therapy
DOI:
https://doi.org/10.3855/jidc.18939Keywords:
paracoccidioidomycosis, immunosuppression, opportunistic, infectionsAbstract
Introduction: Paracoccidioidomycosis is an endemic mycotic infection caused by Paracoccidioides spp., prevalent in Central and South American countries. Anti-tumor necrosis factor (TNF) alpha agents, commonly used for autoimmune diseases, increase the risk of severe infections. We present a case of anti-TNF alpha-related paracoccidioidomycosis in a 71-year-old male farmer from Colombia.
Case presentation: The patient had oral lesions and chronic cough. A biopsy showed granulomatous inflammation with multinucleated giant cells but no microorganisms. Negative microbiological stains and tests for other infections prompted further investigations. A positive serum immunodiffusion test for Paracoccidioides antibodies at a 1:256 titer led to mediastinoscopy and lung biopsy, which revealed budding yeast in a “captain’s wheel” formation. Treatment with liposomal amphotericin B and itraconazole was initiated.
Conclusions: This case highlights the risk of opportunistic infections under anti-TNF alpha therapy and raises awareness of paracoccidioidomycosis associations. Early diagnosis and management are essential for better patient outcomes.
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Copyright (c) 2025 Prof. Jaime Ibarra-Burgos, M.D. MSc., Simón Correa Sierra, M.D., Prof. Sergio Londoño-Tabares, M.D.
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