title: c-ANCA positivity in a Belgian patient with pulmonary paracoccidioidomycosis.
abstract: We present the case of a 69 yr old, white male, suffering from diffuse interstitial lung disease, finally diagnosed as paracoccidioidomycosis or South American blastomycosis. During the course of his disease, antineutrophil cytoplasmic antibodies (c-ANCAs) became positive, suggesting the possibility of a Wegener's granulomatosis. Transbronchial biopsies and a video-assisted thoracoscopic lung biopsy revealed only the pulmonary yeast infection, without other co-existing pathology. During treatment with itraconazole, the patient improved clinically and functionally, and c-ANCAs became negative. Serological monitoring confirmed the diagnosis. To our knowledge, this is the first report describing positive c-ANCAs in a patient with paracoccidioidomycosis. It re-emphasizes the fact that cautious interpretation of c-ANCAs in patients without convincing clinical signs or pathological evidence of a granulomatous vasculitis is absolutely necessary. In this era of increased mobility, a thorough medical history, including documentation of travel, remains an inexpensive tool in making a diagnosis and is still the cornerstone of good medical practice.
authors.affiliation: Dept of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Stappaerts
authors.forename: J
authors.initials: J
authors.lastname: Bogers
authors.forename: D
authors.initials: D
authors.lastname: Ebo
authors.forename: E
authors.initials: E
authors.lastname: Vanden Broecke
authors.forename: W J
authors.initials: WJ
authors.lastname: Stevens
authors.forename: E
authors.initials: E
authors.lastname: Van Marck
authors.forename: P
authors.initials: P
authors.lastname: Vermeire
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D000935:Antifungal Agents; D018572:Disease-Free Survival; D004797:Enzyme-Linked Immunosorbent Assay; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D010229:Paracoccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D012129:Respiratory Function Tests; D020708:Thoracoscopes; D014057:Tomography, X-Ray Computed
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000935:Antifungal Agents; D017964:Itraconazole