CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS

A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) ki...

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Bibliographic Details
Published in:Revista do Instituto de Medicina Tropical de São Paulo 2016-01, Vol.58, p.57
Main Authors: Fernandes, Flávia Fonseca, Alves, Victor Oliveira, Sánchez, Tarquino Erastides Gavilanes, Paula, Wagner Diniz de, Santana, Alfredo Nicodemos Cruz
Format: Article
Language:English
Subjects:
Breast
Breast neoplasms
Case Report
Chylothorax
Chylothorax - diagnosis
Chylothorax - microbiology
Chylous ascites
Diagnosis, Differential
Fatal Outcome
Female
Humans
Middle Aged
Paracoccidioidomycosis
Paracoccidioidomycosis - complications
Paracoccidioidomycosis - diagnosis
TROPICAL MEDICINE
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Summary:A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions.
ISSN:0036-4665
1678-9946
1678-9946
0036-4665
DOI:10.1590/S1678-9946201658057