title: Fatal acute respiratory distress syndrome in a patient with paracoccidioidomycosis: first case report.
abstract: Paracoccidioidomycosis is a systemic mycosis that is usually acquired early in life by inhalation of conidia which convert in the lungs into yeast forms; these in turn trigger an inflammatory process. This mycosis may appear as an acute/subacute form or a chronic, adult form. Acute/subacute presentations can be observed in children and young adults, with the reticuloendothelial system frequently involved but the lungs are usually spared or present with mild clinical or radiological alterations. Acute respiratory distress syndrome (ARDS), an extensive dysfunction of the lungs alveolar-capillary barrier has occasionally been observed in other endemic mycoses such as coccidioidomycosis, cryptococcosis, histoplasmosis and blastomycosis. We describe the first patient with acute paracoccidioidomycosis who developed fatal ARDS accompanied by multiple organ injuries. The basis of the rarity of this entity in patients with paracoccidioidomycosis, as well as the reasons that may have lead to the development of ARDS in this patient are discussed.
authors.affiliation: Laboratory of Dermatology and Immunodeficiencies, and Laboratory of Medical Mycology, Dermatology Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil. mahong@usp.br
authors.forename: Gil
authors.initials: G
authors.lastname: Benard
authors.forename: André Nathan
authors.initials: AN
authors.lastname: Costa
authors.forename: Juliana
authors.initials: J
authors.lastname: Ravanini
authors.forename: Silvia
authors.initials: S
authors.lastname: Goulart
authors.forename: Elisabeth Lima
authors.initials: EL
authors.lastname: Nicodemo
authors.forename: Carmen Sílvia Valente
authors.initials: CS
authors.lastname: Barbas
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Ferraz da Silva
mesh_terms: D017809:Fatal Outcome; D006651:Histocytochemistry; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D009102:Multiple Organ Failure; D010229:Paracoccidioidomycosis / Q000150:complications* / Q000175:diagnosis*; D013902:Radiography, Thoracic; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000473:pathology*; D055815:Young Adult