title: A rare paracoccidioidomycosis diagnosis in a kidney transplant receptor: case report.
abstract: BACKGROUND
  Paracoccidioidomycosis (PCM) is a systemic mycosis of chronic presentation more frequent in adults, which may lead to disseminated severe and lethal forms involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid organs of the digestive tract. Common in Latin America, it is rare in transplanted patients, with few cases described in the literature.
  
  
  OBJECTIVE
  To report a case of a patient who underwent kidney transplant 3 years ago with a pseudotumoral cervical PCM diagnosis.
  
  
  METHODS
  A male patient, 45 years old, who underwent kidney transplantation 3 years ago presenting with diarrhea, severe weight loss, and anemia; no breathing complaints. Parasitological stool tests, fecal culture, urine culture, and abdomen USG were performed in order to assess the diarrhea, and were inconclusive. He was treated with antibiotics and antiparasitic drugs with no improvement and continued with weight loss of 15 kg within 3 months. Immunosuppression was changed, with the mycophenolic acid reduced until it was replaced by everolimus. The diarrhea returned to intensify, and there was an increase in the creatinine (from 1.5 to 3.4). He was empirically treated with sulfamethoxazole/trimethoprim, with total remission of the diarrhea. The patient underwent a kidney biopsy, anti-HIV examinations, PCR BK virus, and PCR for Mycobacterium tuberculosis-with no diagnostic conclusion. During his fifth hospitalization (6 months after the beginning of the diagnostic research), presenting a quite compromised general state, loss of 20 kg, anemia, kidney failure, and fever, he developed skin lesions on the legs and a voluminous and hard tumor in the right cervical region. Chest computed tomography was performed, and the tumoral lesions were removed from those regions. He was started on tuberculostatics and underwent a biopsy of the cervical tumoral lesion.
  
  
  RESULTS
  Biopsy of the cervical tumor showed a fungal infection by paracoccidioidomycosis. The BAAR test of the biopsy was negative. The patient died a few weeks after the diagnosis.
  
  
  CONCLUSIONS
  The association between the organ transplant and PCM is rare and, in unusual clinical presentations, the diagnosis difficulty may compromise a successful treatment.
authors.affiliation: AntônioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraíba, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Pontes
authors.affiliation: AntônioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraíba, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Borborema
authors.affiliation: Unidade Ciêntífica de Diagnóstico-UCD, Campina Grande, Paraíba, Brazil.
authors.forename: C R B
authors.initials: CR
authors.lastname: Correia
authors.affiliation: Unidade Ciêntífica de Diagnóstico-UCD, Campina Grande, Paraíba, Brazil.
authors.forename: W L
authors.initials: WL
authors.lastname: de Almeida
authors.affiliation: AntônioTargino Hospital/Social Institute of Healthcare, Campina Grande, Paraíba, Brazil. Electronic address: rfmaciel@uol.com.br.
authors.forename: R F
authors.initials: RF
authors.lastname: Maciel
mesh_terms: D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D007668:Kidney / Q000382:microbiology / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D066027:Transplant Recipients