title: Fatal septic shock due to a disseminated chronic form of paracoccidioidomycosis in an aged woman.
abstract: Once rare, septic shock (SS) due to disseminated fungal infections has been increasingly reported due to a growing number of immunocompromised patients, but remains rare in non-immune-compromised individuals. In paracoccidioidomycosis, it has been described in only three patients with the severe, acute form of the disease. We describe the development of a refractory, fatal septic shock due to a severe disseminated chronic form of paracoccidioidomycosis in an older woman without any other microbial insults. A striking event in the evolution of her case was the severe depletion of lymphocytes from the peripheral blood and lymphoid organs. Lymphocyte depletion due to apoptosis is described in the late phase of sepsis and can contribute both to immunosuppression and the progression of SS. The possible mechanisms involved in the induction of SS in the chronic form of paracoccidioidomycosis are discussed.
authors: Laboratory of Dermatology and immunodeficiencies (LIM-56), Dermatology Division of the Hospital das Clínicas, Medical School and Laboratory of Medical Mycology (LIM-53), Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil. mahong@usp.br
authors: Gil
authors: G
authors: Benard
authors: Roseli L
authors: RL
authors: Patzina
authors: Juliana Barbosa
authors: JB
authors: Schwab
authors: Thiago C
authors: TC
authors: Gabriel
authors: Yeh-Li
authors: YL
authors: Ho
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017809:Fatal Outcome; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008231:Lymphopenia / Q000175:diagnosis; D008853:Microscopy; D010229:Paracoccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D013902:Radiography, Thoracic; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D013154:Spleen / Q000473:pathology; D014057:Tomography, X-Ray Computed