Infiltrative myelopathy by paracoccidioidomycosis. A review and report of nine cases with emphasis on bone marrow morphology.
OBJECTIVE
To report nine additional well-defined cases with infiltrative myelopathy by paracoccidioidomycosis (PCM), to describe the specific lesions and infection-related stromal abnormalities, to review the literature on this type of involvement and to introduce a new cause of granulomatous lesions of bone marrow.


RESULTS
Different bone marrow specimens were studied (aspirated smears, aspirated clots, biopsy imprints and biopsies) from nine patients with acute or subacute forms of PCM known to have PCM infiltrative myelopathy.


CONCLUSIONS
The biopsy specimens were the best for demonstrating bone marrow involvement by PCM. The lesions varied from compact and focal granulomas with few fungal cells to numerous disseminated fungal cells within a loose granulomatous inflammatory reaction, with a continuum between these extremes suggesting a spectrum of immune response to the fungi. Other findings such as bone marrow fibrosis, parenchymal coagulative necrosis and bone necrosis were also observed in the affected areas.
Clinical Deparmtent, Botucatu Medical School, São Paulo State University, Botucatu, Brazil. luan_resende@uol.com.br
L S R
LS
Resende
R P
RP
Mendes
M M
MM
Bacchi
S A
SA
Marques
B
B
Barraviera
L R
LR
Souza
D A
DA
Meira
L
L
Niéro-Melo
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000209:etiology / Q000473:pathology*; D001856:Bone Marrow Examination; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000150:complications*