PMID- 26036516
OWN - NLM
STAT- MEDLINE
DCOM- 20160112
LR  - 20181202
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 47
IP  - 4
DP  - 2015 May
TI  - A rare paracoccidioidomycosis diagnosis in a kidney transplant receptor: case 
      report.
PG  - 1048-50
LID - S0041-1345(15)00234-1 [pii]
LID - 10.1016/j.transproceed.2015.03.006 [doi]
AB  - INTRODUCTION: Paracoccidioidomycosis (PCM) is a systemic mycosis of chronic 
      presentation more frequent in adults, which may lead to disseminated severe and 
      lethal forms involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid 
      organs of the digestive tract. Common in Latin America, it is rare in 
      transplanted patients, with few cases described in the literature. PURPOSE: To 
      report a case of a patient who underwent kidney transplant 3 years ago with a 
      pseudotumoral cervical PCM diagnosis. METHODS: A male patient, 45 years old, who 
      underwent kidney transplantation 3 years ago presenting with diarrhea, severe 
      weight loss, and anemia; no breathing complaints. Parasitological stool tests, 
      fecal culture, urine culture, and abdomen USG were performed in order to assess 
      the diarrhea, and were inconclusive. He was treated with antibiotics and 
      antiparasitic drugs with no improvement and continued with weight loss of 15 kg 
      within 3 months. Immunosuppression was changed, with the mycophenolic acid 
      reduced until it was replaced by everolimus. The diarrhea returned to intensify, 
      and there was an increase in the creatinine (from 1.5 to 3.4). He was empirically 
      treated with sulfamethoxazole/trimethoprim, with total remission of the diarrhea. 
      The patient underwent a kidney biopsy, anti-HIV examinations, PCR BK virus, and 
      PCR for Mycobacterium tuberculosis-with no diagnostic conclusion. During his 
      fifth hospitalization (6 months after the beginning of the diagnostic research), 
      presenting a quite compromised general state, loss of 20 kg, anemia, kidney 
      failure, and fever, he developed skin lesions on the legs and a voluminous and 
      hard tumor in the right cervical region. Chest computed tomography was performed, 
      and the tumoral lesions were removed from those regions. He was started on 
      tuberculostatics and underwent a biopsy of the cervical tumoral lesion. RESULT: 
      Biopsy of the cervical tumor showed a fungal infection by paracoccidioidomycosis. 
      The BAAR test of the biopsy was negative. The patient died a few weeks after the 
      diagnosis. CONCLUSION: The association between the organ transplant and PCM is 
      rare and, in unusual clinical presentations, the diagnosis difficulty may 
      compromise a successful treatment.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Pontes, A M
AU  - Pontes AM
AD  - AntonioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraiba, 
      Brazil.
FAU - Borborema, J
AU  - Borborema J
AD  - AntonioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraiba, 
      Brazil.
FAU - Correia, C R B
AU  - Correia CR
AD  - Unidade Cientifica de Diagnostico-UCD, Campina Grande, Paraiba, Brazil.
FAU - de Almeida, W L
AU  - de Almeida WL
AD  - Unidade Cientifica de Diagnostico-UCD, Campina Grande, Paraiba, Brazil.
FAU - Maciel, R F
AU  - Maciel RF
AD  - AntonioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraiba, 
      Brazil. Electronic address: rfmaciel@uol.com.br.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
SB  - IM
MH  - Biopsy
MH  - Diagnosis, Differential
MH  - Humans
MH  - Kidney/microbiology/*pathology
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Paracoccidioidomycosis/*diagnosis
MH  - Tomography, X-Ray Computed
MH  - *Transplant Recipients
EDAT- 2015/06/04 06:00
MHDA- 2016/01/13 06:00
CRDT- 2015/06/04 06:00
PHST- 2015/06/04 06:00 [entrez]
PHST- 2015/06/04 06:00 [pubmed]
PHST- 2016/01/13 06:00 [medline]
AID - S0041-1345(15)00234-1 [pii]
AID - 10.1016/j.transproceed.2015.03.006 [doi]
PST - ppublish
SO  - Transplant Proc. 2015 May;47(4):1048-50. doi: 10.1016/j.transproceed.2015.03.006.