[Paracoccidioidomycosis assessed with 4 isotopic studies]

Paracoccidioidomycosis (south-american blastomycosis) is a consumptive granulomatous disease that is found in all Latin-America. The ethiological agent is a fungus (Paracoccidiosis brasiliensis) and mechanisms of disease transmission are not clear. Affection is frequent in the lungs, liver, spleen, ganglia, oropharynx and brain. Disease's response to therapy (Amphotericin, Ketoconazole) is good but recurrence is frequent. We have studied 12 patients with gallium-67, bone scintigraphy, bone marrow scintigraphy and lymph-scintigraphy. Six of these patients were re-studied after variable time of therapy. Gallium-67 accumulated in all patients's lungs. Other abnormal areas included ganglia, liver, spleen and bone. Bone scintigraphy was abnormal in all bone sites that were abnormal at the gallium study. Bone marrow scintigraphy showed expansion to the periphery in 6/12 cases and lymph nodes accumulated the radiopharmaceutical in 5 patients. Patients re-studied after the beginning of therapy presented decreased degrees or normalization of the radio-pharmaceutical's uptake (gallium and MDP), a regression of the bone marrow periphery expansion (bone marrow scintigraphy) and normalization of the lymph node aspects. These four radioisotopical studies may be useful for staging and for therapy follow-up. The sensitivity of the method is greater than the one noted for the conventional radiological studies.