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Fatal disseminated paracoccidioidomycosis in a two-year-old child

Ricardo M Pereira1, Antonia Terezinha Tresoldi, Marcus T N da Silva

  • 1Departamento de Pediatria, FCM, UNICAMP, Campinas, S.P., Brasil. ricardom.p@uol.com.br

Revista Do Instituto De Medicina Tropical De Sao Paulo
|April 2, 2004
PubMed

Insights

A rare pediatric case of septic shock and lymphoproliferative syndrome was caused by Paracoccidioides brasiliensis. This extremely young patient highlights the aggressive nature of disseminated paracoccidioidomycosis in children.

Area of Science:

  • Mycology
  • Pediatric Infectious Diseases
  • Intensive Care Medicine

Background:

  • Lymphoproliferative syndromes can present with severe systemic manifestations in children.
  • Septic shock in pediatric patients necessitates rapid diagnosis and aggressive management.
  • Fungal infections, such as paracoccidioidomycosis, can mimic other hematological and oncological conditions.

Observation:

  • A 2-year-old female presented with septic shock, fever, adynamia, and weight loss.
  • Clinical signs included pallor, jaundice, lymphadenopathy, hepatosplenomegaly, and facial warts.
  • Laboratory findings revealed anemia, eosinophilia, thrombocytopenia, and cholestatic liver injury.

Findings:

  • Microscopic examination of lymph node exudate showed characteristic "pilot wheel" yeast cells, suggestive of Paracoccidioides brasiliensis.
  • Despite prompt initiation of intravenous sulfamethoxazole-trimethoprim, the patient's condition rapidly deteriorated.
  • Autopsy confirmed disseminated paracoccidioidomycosis, representing the youngest reported case in the literature.

Implications:

  • This case underscores the importance of considering rare fungal infections in pediatric septic shock, even in the youngest patients.
  • Early identification of Paracoccidioides brasiliensis is crucial for timely treatment, although outcomes can be poor in disseminated forms.
  • Further research into the pathogenesis and treatment of paracoccidioidomycosis in immunocompromised children is warranted.

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