title: [Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis].
abstract: BACKGROUND
  Systemic histoplasmosis is an invasive fungal infection that may mimic primary vasculitis, particularly granulomatosis with polyangiitis (GPA), and was rarely described in adult patients. We reported an immunocompetent patient with disseminated histoplasmosis mimicking GPA who fulfilled European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) validated classification criteria.
  
  
  METHODS
  A 6-year old boy presented acute migratory polyarthritis with spontaneous improvement, sinus inflammation, fever, headache and abdominal pain. Serologic test for hepatitis, cytomegalovirus, human immunodeficiency virus, Epstein-Barr virus, toxoplasmosis, dengue virus and antistreptolysin O were all negative. Magnetic resonance imaging (MRI) showed moderate ascites in pelvis and pansinusitis. Antineutrophil cytoplasmic antibodies (c-ANCA) were positive. He had spontaneous remission of the symptoms including fever. At the age of 11 years and 11 months, he had sinusitis, pneumonia and epididymitis. A month later, he was hospitalized and MRI showed left eye proptosis. Cerebrospinal fluid was normal and indirect tests of fungi were negative. Two months later, he had lumbar pain and computer tomography showed a mass in the right kidney and pulmonary nodule in the right lung. He fulfilled EULAR/PRINTO/PRES criteria for GPA, however the renal biopsy showed a focal granulomatous interstitial nephritis with yeast fungal cells compatible with Histoplasma sp. He was treated with liposomal amphotericin B and itraconazole with improvement of signs and symptoms.
  
  
  CONCLUSIONS
  We reported a progressive disseminated histoplasmosis case mimicking GPA. Histoplasmosis infection should be considered in immunocompetent subjects with uncommon clinical manifestations, such as arthritis, nephritis and epididymitis.
authors: Faculdade de Medicina, Universidade de Vrije, Amsterdã, Holanda; Departamento de Pedriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Marlon
authors: M
authors: van Weelden
authors: Unidade de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Gabriela R
authors: GR
authors: Viola
authors: Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Katia T
authors: KT
authors: Kozu
authors: Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Nadia E
authors: NE
authors: Aikawa
authors: Unidade de Infectologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Claudia M
authors: CM
authors: Ivo
authors: Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. Electronic address: clovisaasilva@gmail.com.
authors: Clovis A
authors: CA
authors: Silva
keywords: Children; Crianças; Epididimite; Epididymitis; Granulomatose com poliangiíte; Granulomatose de Wegener; Granulomatosis with polyangiitis; Histoplasmose; Histoplasmosis; Wegener's granulomatosis