Osteomyelitis and Aortic Arteritis with thrombosis as primary manifestations of systemic paracoccidioidomycosis: a case report

Abstract

Abstract Background Paracoccidioidomycosis (PCM) is a neglected deep mycosis caused by Paracoccidioides sp. We describe a fatal PCM case, presenting as osteomyelitis, in a man having frequent contact with an endemic region of São Paulo, Brazil. Case presentation: A 67-year-old man who lived in an urban area, had frequent fishing trips to an endemic region. He presented with osteomyelitis of the femur and iliac artery thrombosis at hospital admission. Thoracic CT revealed multiple cavitated lung nodules. The patient rapidly progressed to irreversible respiratory failure. The autopsy revealed disseminated PCM and thrombosis of the iliac artery. Laboratory investigation confirmed a P. brasiliensis infection with phylogenetic results revealing sequences recovered from patient samples grouped with sequences characterized as P. brasiliensis complex. Conclusion Atypical PCM remains a diagnostic challenge. Increased awareness of contagion sites and different clinical presentations will lead to improved patient management.