Unusual clinical course, Challenging differential diagnosis
Mateo Mejia-Zuluaga, Samuel Rosas, Verónica Posada Vélez, Pedro A. Quintero
(Department of Internal Medicine, CES Clinic, Medellin, Colombia)
Am J Case Rep 2017; 18:1114-1117
Paracoccidioidomycosis is an endemic mycosis in Central and South America caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Despite its self-limited course and usually asymptomatic infection, some patients may present with a systemic illness mimicking multiple conditions and thus question the general state of their immune system.
CASE REPORT: A 28-year-old male presented to the hospital with fever, dry cough, and non-pruritic rash with no characteristic distribution for the past 10 days. Past medical history revealed that the patient had worked as a farmer three years ago, had abused cocaine paste over the same period, and also had in the last month presented to the hospital for acute appendicitis. Initial laboratory tests revealed hypereosinophilia greater than 10,000 eosinophils/mL. Infection of P. brasiliensis was confirmed by lymph node, skin, and colonoscopy biopsies. After treatment with itraconazole, the patient’s eosinophil count returned to normal and his symptoms resolved.
CONCLUSIONS: Paracoccidioidomycosis may present as a systemic illness with only marked eosinophilia on initial diagnostic tests. Furthermore, in our patient’s case, the high degree of eosinophilia may have contributed towards the patient’s appendicitis in the weeks preceding the subacute infection. It is possible that the patient’s history of working at a farm and abusing cocaine paste may have contributed to the initial colonization by the fungus.
Keywords: Hypereosinophilic Syndrome, Immunocompetence, Paracoccidioides