{"title":"Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis","authors":"","doi":"10.1016/j.riam.2024.04.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Paracoccidioidomycosis is a neglected tropical disease caused by fungi of the genus <em>Paracoccidioides</em>. A wide range of symptoms is related to the disease; however, lungs and skin are the sites predominantly affected. The disease is mostly seen in people living in rural areas in Latin America.</div></div><div><h3>Case report</h3><div>We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological <em>Paracoccidioides</em> antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge.</div></div><div><h3>Conclusions</h3><div>Due to the intense inflammatory response triggered by <em>Paracoccidioides</em> cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Iberoamericana De Micologia","FirstCategoryId":"99","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1130140624000056","RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MYCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Paracoccidioidomycosis is a neglected tropical disease caused by fungi of the genus Paracoccidioides. A wide range of symptoms is related to the disease; however, lungs and skin are the sites predominantly affected. The disease is mostly seen in people living in rural areas in Latin America.
Case report
We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological Paracoccidioides antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge.
Conclusions
Due to the intense inflammatory response triggered by Paracoccidioides cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.
背景:副球孢子菌病是由副球孢子菌属真菌引起的一种被忽视的热带疾病。该病的症状多种多样,但主要受累部位是肺部和皮肤。这种疾病主要发生在拉丁美洲的农村地区:我们报告了一例严重的播散性副球孢子菌病儿科病例,患者对抗真菌治疗反应缓慢。三个月内,症状演变为肝脾肿大、颈部和腹部淋巴结坏死以及脾脓肿。脱氧胆酸两性霉素 B 和伊曲康唑的临床反应缓慢,导致胸腔和腹腔积液、心力衰竭和休克。脱氧胆酸两性霉素 B 被脂质体制剂取代,但无反应。随后,在治疗中加入了泼尼松,临床反应有所改善。血清学中的副球孢子菌抗体滴度不典型,在临界期滴度很低,而在恢复期滴度显著升高。通过使用脱氧胆酸两性霉素 B、两性霉素 B 脂质体和皮质类固醇,感染最终被清除。出院后两年,副球孢子菌病血清学检查未见反应:结论:由于副球孢子菌细胞引发了强烈的炎症反应,短期使用小剂量泼尼松可调节炎症反应,支持抗真菌治疗。
期刊介绍:
Revista Iberoamericana de Micología (Ibero-American Journal of Mycology) is the official journal of the Asociación Española de Micología, Asociación Venezolana de Micología and Asociación Argentina de Micología (The Spanish, Venezuelan, and Argentinian Mycology Associations). The Journal gives priority to publishing articles on studies associated with fungi and their pathogenic action on humans and animals, as well as any scientific studies on any aspect of mycology. The Journal also publishes, in Spanish and in English, original articles, reviews, mycology forums, editorials, special articles, notes, and letters to the editor, that have previously gone through a scientific peer review process.