PMID- 38055375
OWN - NLM
STAT- MEDLINE
DCOM- 20231211
LR  - 20240110
IS  - 1678-9946 (Electronic)
IS  - 0036-4665 (Print)
IS  - 0036-4665 (Linking)
VI  - 65
DP  - 2023
TI  - Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from 
      an atypical chronic form of the mycosis.
PG  - e57
LID - S0036-46652023000100224 [pii]
LID - 10.1590/S1678-9946202365057 [doi]
LID - e57
AB  - Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by 
      Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic 
      form (CF) and rarely as a mixed form combining the features of the two 
      aforementioned forms in an immunocompromised patient. Here, we report a 
      56-year-old male patient with CF-PCM who presented with atypical manifestations, 
      including the development of an initial esophageal ulcer, followed by central 
      nervous system (CNS) lesions and cervical and abdominal lymphatic involvement 
      concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no 
      other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its 
      mycotic etiology. He was hospitalized for treatment of COVID-19 and required 
      supplemental oxygen in the intensive unit. The patient recovered without the need 
      for invasive ventilatory support. Investigation of the extent of disease during 
      hospitalization revealed severe lymphatic involvement typical of A/SAF, although 
      the patient;s long history of high-risk exposure to PCM, and lung involvement 
      typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM 
      patients. CNS involvement is also rare. We suggest that the immunological 
      imbalance caused by the severe COVID-19 infection may have contributed to the 
      patient developing atypical severe CF, which resembles the PCM mixed form of 
      immunosuppressed patients. Severe COVID-19 infection is known to impair the 
      cell-mediated immune response, including the antiviral response, through 
      T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize 
      that these alterations would also impair antifungal defenses. Our case highlights 
      the potential influence of COVID-19 on the course of PCM. Fortunately, the 
      patient was timely treated for both diseases, evolving favorably.
FAU - Souza, Cesar Augusto Tomaz de
AU  - Souza CAT
AUID- ORCID: 0000-0003-1413-4918
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
FAU - Ponce, Cesar Cilento
AU  - Ponce CC
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
AD  - Instituto Adolfo Lutz, Sao Paulo, Sao Paulo, Brazil.
FAU - Klautau, Gisele Burlamaqui
AU  - Klautau GB
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
AD  - Santa Casa de Sao Paulo, Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil.
FAU - Marques, Nathan Costa
AU  - Marques NC
AD  - Universidade de Sao Paulo, Faculdade de Medicina, Departamento de 
      Cardio-Pneumologia, Sao Paulo, Sao Paulo, Brazil.
FAU - Queiroz, Wladimir
AU  - Queiroz W
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
FAU - Patzina, Rosely Antunes
AU  - Patzina RA
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
FAU - Benard, Gil
AU  - Benard G
AUID- ORCID: 0000-0002-5469-3602
AD  - Universidade de Sao Paulo, Faculdade de Medicina, Instituto de Medicina Tropical 
      de Sao Paulo, Laboratorio de Micologia Medica (LIM-53), Sao Paulo, Sao Paulo, 
      Brazil.
FAU - Lindoso, Jose Angelo Lauletta
AU  - Lindoso JAL
AUID- ORCID: 0000-0002-4405-4401
AD  - Instituto de Infectologia Emilio Ribas, Sao Paulo, Sao Paulo, Brazil.
AD  - Universidade de Sao Paulo, Faculdade de Medicina, Instituto de Medicina Tropical 
      de Sao Paulo, Laboratorio de Protozoologia (LIM-49), Sao Paulo, Sao Paulo, 
      Brazil.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20231201
PL  - Brazil
TA  - Rev Inst Med Trop Sao Paulo
JT  - Revista do Instituto de Medicina Tropical de Sao Paulo
JID - 7507484
RN  - 0 (Antifungal Agents)
SB  - IM
EIN - Rev Inst Med Trop Sao Paulo. 2024 Jan 05;66:e57err. PMID: 38198379
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - *Paracoccidioidomycosis/complications/diagnosis
MH  - Ulcer
MH  - *COVID-19/complications
MH  - SARS-CoV-2
MH  - Antifungal Agents/therapeutic use
MH  - *Paracoccidioides
PMC - PMC10691805
COIS- CONFLICT OF INTERESTS The authors declare that they have no conflict of 
      interests.
EDAT- 2023/12/06 18:42
MHDA- 2023/12/11 12:43
PMCR- 2023/12/01
CRDT- 2023/12/06 12:43
PHST- 2023/08/21 00:00 [received]
PHST- 2023/10/10 00:00 [accepted]
PHST- 2023/12/11 12:43 [medline]
PHST- 2023/12/06 18:42 [pubmed]
PHST- 2023/12/06 12:43 [entrez]
PHST- 2023/12/01 00:00 [pmc-release]
AID - S0036-46652023000100224 [pii]
AID - 10.1590/S1678-9946202365057 [doi]
PST - epublish
SO  - Rev Inst Med Trop Sao Paulo. 2023 Dec 1;65:e57. doi: 10.1590/S1678-9946202365057. 
      eCollection 2023.