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Severe juvenile type paracoccidioidomycosis in an adult
G Benard1, C P Neves, R C Gryschek
1Immunogenetic and Experimental Transplantation Laboratory, Medical School of Sö Paulo University, Brazil.
Abstract:
Paracoccidioidomycosis has recently been classified into juvenile (acute) and adult (chronic) forms. The latter affects middle-aged men and causes mucocutaneous lesions, while the more rare juvenile form affects the reticuloendothelial system of children and adults of both sexes under 30 years of age. It is not yet known, however, if the patient's age has a role in determining the immune response patterns to the fungus and the evolution to one form or the other. We present a 45-year-old man who presented with juvenile type disease characterized by intra-abdominal polyadenopathy forming a large epigastric mass. Immune evaluation showed high titres of anti-Paracoccidioides brasiliensis antibodies and an antigen-specific cellular immune defect. Treatment resulted in resolution of the clinical and immune abnormalities. His epidemiological background also suggested acute disease: he developed disease after moving from an urban to a rural endemic area. We suggest that acute or juvenile disease may occur in a previously healthy, susceptible individual when moving to an endemic area, at whatever age.
Insights
Juvenile Paracoccidioidomycosis can affect adults, not just children. A 45-year-old man with juvenile disease showed immune defects, suggesting age is not the sole factor in Paracoccidioidomycosis presentation.
Area of Science:
- Mycology
- Immunology
- Infectious Diseases
Background:
- Paracoccidioidomycosis (P. brasiliensis) is a fungal infection.
- Classified into juvenile (acute) and adult (chronic) forms.
- Age's role in immune response and disease form is unclear.
Observation:
- A 45-year-old man presented with juvenile-type Paracoccidioidomycosis.
- Symptoms included intra-abdominal polyadenopathy and an epigastric mass.
- He moved from an urban to a rural endemic area.
Findings:
- High anti-P. brasiliensis antibody titers were observed.
- An antigen-specific cellular immune defect was identified.
- Treatment led to clinical and immune recovery.
Implications:
- Juvenile Paracoccidioidomycosis may occur in adults of any age.
- Susceptibility may be linked to environmental exposure in endemic areas.
- Further research needed on age-independent immune responses in Paracoccidioidomycosis.