Psoas abscesses caused by Paracoccidioides brasiliensis in an adolescent.
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.
Neves
Mariana Tresoldi
MT
Department of Pediatrics, Faculty of Medical Science, University of Campinas, Campinas, Brazil.
Livani
Bruno
B
Belangero
William Dias
WD
Tresoldi
Antonia Teresinha
AT
Pereira
Ricardo Mendes
RM
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
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
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