XI International Meeting on Paracoccidioidomycosis

XI International Meeting on Paracoccidioidomycosis

Resume:152-2

Poster (Painel)

152-2

Unifocal bone paracoccidioidomycosis. Case report with follow-up.

Authors:

Bruna Correa Castro (UFMS - Universidade Federal de Mato Grosso do Sul) ; Danilo Odashiro (LAC - Laboratório de Anatomia Patológica de Campo Grande) ; Adalberto Arao-filho (SONIMED - Sonimed Nuclear) ; Maçanori Odashiro (UFMS - Universidade Federal de Mato Grosso do SulLAC - Laboratório de Anatomia Patológica de Campo Grande) ; Maurico Antonio Pompilio (UFMS - Universidade Federal de Mato Grosso do Sul) ; Anamaria Mello Miranda Paniago (UFMS - Universidade Federal de Mato Grosso do Sul)

Abstract

Introduction. Paracoccidioidomycosis (PCM) is a systemic fungal disease caused by the fungus Paracoccidioides brasiliensis. It is acquired through inhalation and spreads via lympho-hematogenous. It can affect any organ or tissue, most commonly skin, mucous membranes and lungs. The unifocal bone impairment has been rarely reported. Case report. A 47 years old white male farmer sought medical attention with pain in the left leg that had started a month ago. There were no fever, cough, asthenia, weight loss, change in bowel habits and trauma at the pain focus. Alcoholic for 20 years, he did not smoke. The left leg presented severe pain by palpation of the middle third; a slight local volume increase with inflammatory signs and moderate edema at the left ankle, by the physical examination. The X-ray study showed an ovaled osteolytic lesion on the tibial middle third diaphysis. The patient underwent open biopsy and lesion curettage. The bacterioscopy by Gram and bacterial culture did not show the presence of microorganisms. The histopathological report showed bone tissue with inflammation composed by lymphocytes, histiocytes, neutrophils and multinucleated giant cells permeated by round, encapsulated structures, identified as Paracoccidioides brasiliensis and with the malignancy criteria absence. Serologic testing for paracoccidioidomycosis (Agar immunodiffusion), chest radiography and fungi research in sputum in two samples were normal or negative. A bone scintigraphic study with technetium-99m MDP showed images with focal hiper-capitation of the radiopharmaceutical in a emphatic degree on the left tibia middle third. On the other bone structures there were radiopharmaceutical physiologic distribution. Sulfamethoxazole and trimethoprim (co-trimoxazole) was began and he was instructed to walk with the aid of crutches until the lesion cicatrization evidence. The patient presented significant clinical improvement after three months. The radiological control after 10 months the lesion was healed. The treatment was completed 24 months. One year after, the patient is asymptomatic. Conclusion. PCM must enter in the differential diagnosis of osteolytic lesions, even in the absence of pulmonary radiological findings, in endemic regions. Co-trimoxazole was effective.

Keyword: bone, osteolysis, Paracoccidioidomycosis

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