GASTROINTESTINAL PARACOCCIDIOIDOMYCOSIS IN AN ADOLESCENT: CASE REPORT

Case Presentation A 15-year-old female patient sought medical attention complaining of persistent abdominal pain, fever, diarrhea with blood, and weight loss for approximately 3 months. On examination, she was pale, afebrile, and had a slightly distended abdomen. During the evaluation, colonoscopy revealed distortion and stenosis of the terminal ileum, multiple polypoid formations, ulcerations, friability in the colon, and circumferential stenosis in the rectum. Laboratory tests revealed anemia and leukocytosis, while abdominal and thoracic CT scans suggested granulomatous infectious lymphadenopathy, inflammatory bronchopathy, and enteritis. After histopathological confirmation of paracoccidioidomycosis (PCM), the patient was referred for hospital treatment, which included metronidazole, amphotericin B, and itraconazole. After 16 days, she was discharged with ongoing itraconazole treatment. One year later, she returned asymptomatic and is under outpatient follow-up, awaiting a new colonoscopy due to inadequate sample collection in the last test.

Discussion Paracoccidioidomycosis (PCM), a systemic fungal infection caused by Paracoccidioides brasiliensis, is common in Latin America. It is transmitted by inhalation of conidia and is asymptomatic in 80% of cases, but when symptomatic, it can cause fever, cough, and dyspnea. PCM manifests in two forms: juvenile (acute/subacute) with involvement of the reticuloendothelial system, and adult/chronic (90% of cases), primarily affecting the lungs. Gastrointestinal involvement is rare, and it may mimic inflammatory diseases like Crohn's disease, with symptoms such as abdominal pain, nausea, and diarrhea. The diagnosis is made by identifying fungal elements in histopathological and microbiological tests. Treatment includes systemic antifungals like amphotericin B and itraconazole.

Conclusion This case highlights the rarity of gastrointestinal PCM and the complexity of its diagnosis. A teenager presented with gastrointestinal PCM, a rare and challenging condition that mimicked Crohn’s disease. The diagnosis was confirmed by biopsy, and antifungal treatment resulted in significant clinical improvement without the need for surgical intervention. The positive response to treatment underscores the importance of early diagnosis and appropriate treatment. PCM should be considered in the differential diagnosis of inflammatory bowel diseases, particularly in endemic areas.

Publication History

Article published online:
25 April 2025