Abstract

Paracoccidioidomycosis (PCM) is treated with different classes of antifungal drugs, but the role, if any, of adjunct therapy with costicosteroids, as seen in other chronic granulomatous diseases, is unknown. We propose that costicosteroids may have a role in the treatment of some cases of PCM because in such cases there may be a detrimental exaccerbated inflammatory response. We present two patients recently admitted at our service who provide some evidence in favor of their beneficial role.਀倀愀琀椀攀渀琀 ㄀ 椀猀 愀 㐀㐀 礀攀愀爀猀ⴀ漀氀搀 洀愀渀 眀椀琀栀 愀 栀椀猀琀漀爀礀 漀昀 愀戀搀漀洀椀渀愀氀 瀀愀椀渀Ⰰ 眀攀椀最栀琀 氀漀猀猀 愀渀搀 昀攀瘀攀爀⸀ 䔀渀搀漀猀挀漀瀀椀挀 攀砀愀洀椀渀愀琀椀漀渀 眀愀猀 渀漀爀洀愀氀 戀甀琀 愀戀搀漀洀椀渀愀氀 氀礀洀瀀栀愀搀攀渀漀瀀愀琀栀礀 眀愀猀 猀攀攀渀 漀渀 甀氀琀爀愀猀漀渀漀最爀愀瀀栀礀⸀ 䴀刀䤀 猀栀漀眀攀搀 愀 挀漀渀最氀漀洀攀爀愀琀攀 漀昀 挀漀愀氀攀猀挀攀渀琀 椀渀昀氀愀洀攀搀 氀礀洀瀀栀 渀漀搀攀猀 漀渀 琀栀攀 洀攀猀攀渀琀攀爀椀挀 愀爀攀愀⸀ 䄀 戀椀漀瀀猀礀 眀愀猀 搀漀渀攀 戀礀 瘀椀搀攀漀氀愀瀀愀爀漀猀挀漀瀀礀⸀ 䄀渀 椀渀椀琀椀愀氀 爀攀瀀漀爀琀 猀琀愀琀攀搀 ᰀ礠攀愀猀琀 挀攀氀氀猀 猀甀最最攀猀琀椀瘀攀 漀昀 䌀爀礀瀀琀漀挀漀挀挀甀猀 猀瀀ᴀ⸠ 䘀氀甀挀漀渀愀稀漀氀攀 ⠀㠀　　 洀最⼀搀愀礀⤀  眀愀猀 猀琀愀爀琀攀搀 戀甀琀 猀琀漀瀀瀀攀搀 愀昀琀攀爀 ㌀ 搀愀礀猀 眀栀攀渀 愀 搀攀昀椀渀椀琀椀瘀攀 爀攀瀀漀爀琀 眀愀猀 漀戀琀愀椀渀攀搀 眀栀椀挀栀 搀椀愀最渀漀猀攀搀 倀䌀䴀⸀ 䠀攀 眀愀猀 琀栀攀渀 琀爀攀愀琀攀搀 眀椀琀栀 猀甀氀昀愀搀椀愀稀椀渀攀 眀椀琀栀 洀愀爀欀攀搀 椀洀瀀爀漀瘀攀洀攀渀琀⸀ 吀眀漀 眀攀攀欀猀 愀昀琀攀爀 栀漀猀瀀椀琀愀氀 搀椀猀挀栀愀爀最攀 琀栀攀 瀀愀琀椀攀渀琀 眀愀猀 爀攀愀搀洀椀琀琀攀搀 愀琀 琀栀攀 攀洀攀爀最攀渀挀礀 猀攀爀瘀椀挀攀 昀漀爀 愀渀 愀挀甀琀攀 愀戀搀漀洀攀渀 搀甀攀 琀漀 椀渀琀攀猀琀椀渀愀氀 猀甀戀ⴀ漀挀挀氀甀猀椀漀渀⸀ 䌀漀洀瀀甀琀攀搀 琀漀洀漀最爀愀瀀栀礀 猀栀漀眀攀搀 愀 洀愀猀猀 漀昀 挀漀愀氀攀猀挀攀渀琀 氀礀洀瀀栀 渀漀搀攀猀 挀漀洀瀀爀攀猀猀椀渀最 琀栀攀 琀爀愀渀猀瘀攀爀猀攀 挀漀氀漀渀⸀ 䤀渀琀爀愀瘀攀渀漀甀猀 挀漀爀琀椀挀漀猀琀攀爀漀椀搀 愀渀搀 琀爀椀洀攀琀漀瀀爀椀洀ⴀ猀甀氀昀愀洀攀琀栀漀砀愀稀漀氀 眀攀爀攀 瀀爀攀猀挀爀椀戀攀搀 愀渀搀 愀昀琀攀爀 㘀 搀愀礀猀 琀栀攀 猀甀戀ⴀ漀挀挀氀甀猀椀漀渀 爀攀猀漀氀瘀攀搀Ⰰ 愀瘀漀椀搀椀渀最 琀栀攀 渀攀攀搀 漀昀 愀 猀甀爀最椀挀愀氀 椀渀琀攀爀瘀攀渀琀椀漀渀⸀ 倀愀琀椀攀渀琀 栀愀猀 渀漀眀 戀攀攀渀 搀椀猀挀栀愀爀最攀搀 愀渀搀 椀猀 戀攀椀渀最 欀攀瀀琀 漀渀 猀甀氀昀愀搀椀愀稀椀渀攀 愀渀搀 ㈀　 洀最 瀀爀攀搀渀椀猀漀渀攀 琀爀攀愀琀洀攀渀琀⸀ Patient 2 is a 38 years-old man who had an 8-months history of laryngeal pain, dysphagia, hoarseness and weight loss. Chest ray showed bilateral interstitial infiltrates compatible with PCM. A laryngoscopy with biopsy was performed. During the procedure a tracheostomy was performed due to severe reduction of air passage by the inflammatory process. This biopsy showed PCM. The patient received sulfadiazine associated with 1mg/kg prednisone to prevent total occlusion of the airway and to accelerate the subsequent removal of the tracheal cannula. A new laryngoscopy performed 15 days later showed almost complete resolution of the obstructive process. The corticosteroid dose was then progressively tapered. The patient evolved without further complications and is now improving on sulfadiazine therapy only.਀ Conclusion: corticosteroids played a significant beneficial role in the treatment of the two patients with diseminated PCM.਀㰀⼀昀漀渀琀㸀㰀⼀瀀㸀㰀戀爀㸀㰀戀㸀䬀攀礀眀漀爀搀㨀 㰀⼀戀㸀☀渀戀猀瀀㬀挀漀爀琀椀挀漀猀琀攀爀漀椀搀猀Ⰰ 搀椀猀猀攀洀椀渀愀琀攀搀 瀀愀爀愀挀漀挀挀椀搀椀漀椀搀漀洀礀挀漀猀椀猀Ⰰ 琀爀攀愀琀洀攀渀琀㰀⼀琀搀㸀㰀⼀琀爀㸀㰀⼀琀愀戀氀攀㸀㰀⼀琀爀㸀㰀⼀琀搀㸀㰀⼀琀愀戀氀攀㸀㰀⼀戀漀搀礀㸀㰀⼀栀琀洀氀㸀