ÿþ<HTML><HEAD><TITLE>XI International Meeting on Paracoccidioidomycosis</TITLE><link rel=STYLESHEET type=text/css href=css.css></HEAD><BODY aLink=#ff0000 bgColor=#FFFFFF leftMargin=0 link=#000000 text=#000000 topMargin=0 vLink=#000000 marginheight=0 marginwidth=0><table align=center width=700 cellpadding=0 cellspacing=0><tr><td align=left bgcolor=#cccccc valign=top width=550><font face=arial size=2><strong><font face=Verdana, Arial, Helvetica, sans-serif size=3><font size=1>XI International Meeting on Paracoccidioidomycosis</font></font></strong><font face=Verdana size=1><b><br></b></font><font face=Verdana, Arial,Helvetica, sans-serif size=1><strong> </strong></font></font></td><td align=right bgcolor=#cccccc valign=top width=150><font face=arial size=2><strong><font face=Verdana, Arial, Helvetica, sans-serif size=1><font size=1>Resume:137-5</font></em></font></strong></font></td></tr><tr><td colspan=2><br><br><table align=center width=700><tr><td><b>Poster (Painel)</b><br><table width="100%"><tr><td width="60">137-5</td><td><b>Paracoccidioidomycosis in a renal transplant recipient . A case report.</b></td></tr><tr><td valign=top>Authors:</td><td>Letícia C Lastória (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; Luis Gustavo Modelli de Andrade (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; Mariangela Esther Alencar Marques (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; José Morceli (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; <u>Rinaldo Poncio Mendes </u> (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) </td></tr></table><p align=justify><b><font size=2>Abstract</font></b><p align=justify class=tres><font size=2><b>Introduction.</b> Paracoccidioidomycosis (PCM) usually compromises healthy individuals from well known endemic areas. Report of PCM cases in immunocompromised patients are scarce and constitutes the aim of this study. <b>Case report.</b> A 38-year-old male, from São Manuel municipality, Botucatu Region, had a membranoproliferative glomerulonephritis diagnosed in 1998, which evolved to chronic renal failure. He was submitted to a renal transplantation from a living related donor on November 22, 2006, followed by immunosupression therapy. On March 9, 2010 he was attended due a 5-month history of weight loss and a 2-week unproductive cough and fever at evenings. Physical examination revealed a temperature of 36.8oC, pulse rate of 76/min., respiratory rate of 21/min., and blood pressure of 120x80mmHg. Except for hyperchromic papules with elevated and well defined borders in the abdominal region, an exulcerated lesion with a 1.0 cm diameter and central crust in the right lumbar region, and fine rales in the right apex, the remainder of the examination was within normal limits. Chest radiograph showed bilateral cavitary nodules and an alveolar opacity in the right inferior lobe. Bronchoscopy revealed only a chronic bronchitis; bronchoalveolar lavage showed no tumoral cells or acid-fast bacilli. Chest CT revealed thick-walled cavitary nodules and masses, small centrilobular nodules and areas of consolidation surrounded by ground-glass opacities, and some patchy air-space consolidations. Double agar gel immunodiffusion test, carried out with <i>Paracoccidioides brasiliensis</i> culture filtrate antigen, showed specific serum antibodies at a 1/16 dilution. Histopathological examination of a biopsied skin lesion revealed typical <i>P. brasiliensis</i> yeast forms. At that time the patient was receiving mycophenolate (720mg q12hrs), tacrolimus (3.0mg q12 hrs) and prednisone (5.0mg q24hrs). PCM therapy was carried out with the trimetoprim-sulfametoxazole combination (240 - 1,200mg q12hrs). Skin lesion and fever disappeared after two weeks of treatment. Body weight and chest radiograph became normal. The patient completed 1.0-year follow-up. <b>Conclusion.</b> In its endemic regions, PCM must be considered as potential diagnosis of diseases presented by immunocompromised patients. TMP-SMZ was a good choice for treatment because of its efficacy and absence of interaction with the immunosupressed drugs used. </font></p><br><b>Keyword: </b>&nbsp;Paracoccidioidomycosis, renal transplant, immunocompromised patients</td></tr></table></tr></td></table></body></html>