DISSEMINATED JUVENILE PARACOCCIDIOIDOMYCOSIS AND MILIARY TUBERCULOSIS COINFECTION. REPORT OF A CLINICAL CASE.

Abstract

Paracoccidioidomycosis (PMC) is a chronic, systemic, granulomatous disease, limited to the American continent, endemic in Venezuela, with a very varied clinical presentation, it is prevalent in the adult population, for which there are few reports in children. Co-infection of tuberculosis with deep mycoses can occur simultaneously or sequentially. The data in the literature indicate that the frequency of this combination ranges between 5.5 and 19%, with the deficiency of cellular immunity being the main factor in both entities. A clinical case of a 13-year-old male adolescent is presented, who presents with adenomegalic syndrome with a predominance in the cervical region, associated with fever, diffuse abdominal pain and malnutrition, antibiotic treatment with clindamycin is indicated without improvement, which is why lymph node excision is performed cervical, the pathological study reports Paracoccidiodes brasiliensis, initiating treatment with amphotericin B. Abdominal pain reappears, acute appendicitis is diagnosed, undergoing surgery, performing an appendectomy and excision of the mesenteric ganglion. The pathological results of the cecal appendix report periapendicular peritonitis, presence of isolated alcohol-resistant bacilli compatible with tuberculosis and of the mesenteric ganglion. Chronic granulomatous inflammatory infiltrate by Paracoccidiodes brasiliensis and alcohol-resistant bacilli. Given these findings, the diagnosis of paracoccidiodomycosis and miliary tuberculosis coinfection was concluded. Treatment with itraconazole, trimethoprim / sulfamethoxazole, and antifungal treatment based on isoniazid, rifampin, pyrazinamide, and ethambutol are indicated, presenting a favorable evolution. Conclusion The coinfection of PCM with tuberculosis has been recognized, which is why it should be ruled out in all patients with a diagnosis of PMC