Chronic Paracoccidioidomycosis with adrenal involvement mimicking tuberculosis - A case report from Austria

Gernot Wagner; Deddo Moertl; Axel Eckhardt; Ulrich Sagel; Friedrich Wrba; Karl Dam; Birgit Willinger

doi:10.1016/j.mmcr.2016.12.002

Chronic Paracoccidioidomycosis with adrenal involvement mimicking tuberculosis - A case report from Austria

Med Mycol Case Rep. 2016 Dec 2:14:12-16. doi: 10.1016/j.mmcr.2016.12.002. eCollection 2016 Dec.

Authors

Gernot Wagner¹, Deddo Moertl², Axel Eckhardt³, Ulrich Sagel⁴, Friedrich Wrba⁵, Karl Dam³, Birgit Willinger⁶

Affiliations

¹ Clinical Department of Internal Medicine II, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria; Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria.
² Clinical Department of Internal Medicine III, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria.
³ Clinical Department of Internal Medicine II, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria.
⁴ Institute for Hygiene and Microbiology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria.
⁵ Department of Clinical Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
⁶ Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Abstract

Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis and endemic in certain areas of Central and South America. We report a case of a 62-year-old-man with a complex history of tuberculosis and imaging findings of a cerebral lesion and bilateral adrenal enlargement. Biopsy of adrenal gland revealed Paracoccidioides brasiliensis. This case highlights the importance of travel history for diagnosis of paracoccidioidomycosis in non-endemic areas and emphasizes the clinical and histopathological similarities with tuberculosis.

Keywords: Bilateral adrenal enlargement; Endemic systemic mycosis; Paracoccidioides brasiliensis; Paracoccidioidomycosis; Tuberculosis.