Purpose or Case Report: This education exhibit aims to:
Provide a concise overview of the imaging aspects of the paracoccicidioidomycosis in childhood
Illustrate and discuss the main radiological findings of these endemic mycotic infection in Brazil
Methods & Materials: We searched at the Hospital da Criança e Maternidade de São José do Rio Preto electronic medical records and reviewed the radiology picture archiving, including all available imaging exams (radiograph, CT scans, MRI, and ultrasound) between 2013 and 2015. Excisional node biopsy was used as a confirmatory diagnosis.
Results: Five patients (1 girl and 4 boys) in the last 2 years were diagnosed with paracoccicidioidomycosis in our tertiary hospital, with ages between 4 and 25 years. At the initial analyses of the images none of the radiologist suggested the hypothesis of paracoccicidioidomycosis. In fact, in 4 cases the suggested diagnose were lymphoma like disease; one case systemic tuberculosis and the other one pneumonia.
Conclusions: Paracoccicidioidomycosis is a fungical granulomatous disease caused by Paracoccidioides brasiliensis, which is considered the most important systemic mycosis in Latin America and is endemic in Brazil.
Inhalation of the fungus is the most common form of disease transmission; however traumatic inoculation can also occur.
Although the infection is mostly acquired between 10-20 years of age, clinical manifestations and progression to disease are not common in this group. This is why nearly 95% of the cases occur in adults as a chronic disease, manifested by mucosal and pulmonary involvement. Children, adolescents and young adults (under 30 years of age) are generally affected by an acute or subacute form, know as juvenile paracoccicidioidomycosis with a rapid course and marked involvement of the reticuloendothelial system, without mucosal lesions. The imaging findings in juvenile form are generalized lymphadenopathy and hepatoesplenomegaly.
The diagnosis is based upon fungus microscopic visualization and/or culture, and sorologic testing. Imaging methods are very helpful to identify the structures involvement, however, there are no specific pattern of this disease.
In the absence of therapy mortality rates are high, making the suspicion essential for the satisfactory prognosis of the disease. The objective of this educational review is awareness radiologists that a lymphoproliferative aspect of a systemic or localized disease in endemic areas can represent a paracoccicidioidomycosis infection.