Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis

Armando Guevara; Nathan Pereira Siqueira; Ronaldo Pereira de Sousa; Thiago Braga Dos Santos; Sandra Breder Assis; Zoilo Pires de Camargo; Anderson Messias Rodrigues; Ferry Hagen; Rosane Christine Hahn

doi:10.1016/j.riam.2024.04.001

Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis

Armando Guevara, Nathan Pereira Siqueira, Ronaldo Pereira de Sousa, Thiago Braga Dos Santos, Sandra Breder Assis, Zoilo Pires de Camargo, Anderson Messias Rodrigues, Ferry Hagen, Rosane Christine Hahn

Research output: Contribution to journal/periodical › Article › Scientific › peer-review

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.

Original language	English
Journal	Revista Iberoamericana de Micologia
DOIs	https://doi.org/10.1016/j.riam.2024.04.001
Publication status	E-pub ahead of print - 18 Jun 2024

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10.1016/j.riam.2024.04.001

Cite this

@article{316a6398d15744fe800f298dd144eb93,

title = "Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis",

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.",

author = "Armando Guevara and Siqueira, {Nathan Pereira} and {de Sousa}, {Ronaldo Pereira} and {Dos Santos}, {Thiago Braga} and Assis, {Sandra Breder} and {de Camargo}, {Zoilo Pires} and Rodrigues, {Anderson Messias} and Ferry Hagen and Hahn, {Rosane Christine}",

year = "2024",

month = jun,

day = "18",

doi = "10.1016/j.riam.2024.04.001",

language = "English",

journal = "Revista Iberoamericana de Micologia",

issn = "1130-1406",

publisher = "Asociacion Espanola de Micologia",

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T1 - Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis

AU - Guevara, Armando

AU - Siqueira, Nathan Pereira

AU - de Sousa, Ronaldo Pereira

AU - Dos Santos, Thiago Braga

AU - Assis, Sandra Breder

AU - de Camargo, Zoilo Pires

AU - Rodrigues, Anderson Messias

AU - Hagen, Ferry

AU - Hahn, Rosane Christine

PY - 2024/6/18

Y1 - 2024/6/18

N2 - 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.

AB - 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.

U2 - 10.1016/j.riam.2024.04.001

DO - 10.1016/j.riam.2024.04.001

M3 - Article

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SN - 1130-1406

JO - Revista Iberoamericana de Micologia

JF - Revista Iberoamericana de Micologia

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