title: Psoas abscesses caused by Paracoccidioides brasiliensis in an adolescent.
abstract: OBJECTIVE
  In order to describe the case of an adolescent who developed psoas abscesses caused by Paracoccidiodes brasiliensis.
  
  
  METHODS
  A 12-year-old boy was admitted with a history of daily fever and global lymph nodes enlargement. He had been treated in the last 6 years, with irregular use of the drugs, for an acute form of paracoccidioidomycosis (PCM). He presented a tenderness fluctuating polyadenopathy in all cervical, submandibular, supraclavicular, axillary, and inguinal chains; several lymph nodes were up to 4 cm in diameter, hardened and coalescent. After 1 month of unsuccessful therapy with SMX-TMP, the patient presented a pain in the right groin and difficulty to walk. CT scan showed a global retroperitoneal lymph nodes enlargement, some with central necrosis and two bigger collections adjacent to both psoas muscles. A surgical drainage of the collections was performed for several times. The patient received a total of 1.9 g of Amphotericin B. After 1 month of the last surgical procedure, CT scan showed only a residual collection, and the patient was sent to ambulatory follow-up. We hypothesed that the retroperitoneal lymph nodes became a coalescent mass that fistulized to the psoas compartment.
  
  
  CONCLUSIONS
  The patient presented a febrile lymphoproliferative syndrome that is frequently seen in children with PCM. Although a polymorphic manifestation is observed in this disease, psoas abscess is a rare complication of PCM. The health professionals that take care of the patients with PCM must pay attention to the possibility of this one more complication.
authors.affiliation: Department of Pediatrics, Faculty of Medical Science, University of Campinas, Campinas, Brazil.
authors.forename: Mariana Tresoldi
authors.initials: MT
authors.lastname: Neves
authors.forename: Bruno
authors.initials: B
authors.lastname: Livani
authors.forename: William Dias
authors.initials: WD
authors.lastname: Belangero
authors.forename: Antonia Teresinha
authors.initials: AT
authors.lastname: Tresoldi
authors.forename: Ricardo Mendes
authors.initials: RM
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D023801:Directly Observed Therapy; D005334:Fever; D006801:Humans; D007262:Infusions, Intravenous; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D010228:Paracoccidioides / Q000302:isolation & purification; D010229:Paracoccidioidomycosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D010349:Patient Compliance; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
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