CHEST Guidelines-A-54-Year-Old-Man-With-Lingual-Granuloma-and-Multi

A-54-Year-Old-Man-With-Lingual-Granuloma-and-Multi

Pdf Summary

A 54-year-old French man presented with chronic lingual granuloma, mandibular lymphadenopathy, and multiple pulmonary nodules. His past involved significant substance use and living in Latin America over a decade ago. Laboratory tests showed an elevated C-reactive protein level, and screening for various infections, including HIV, returned negative, though an atypical pattern emerged from antineutrophil cytoplasmic antibodies screening. A biopsy of the tongue lesion revealed granulomatous inflammation and yeast forms consistent with Paracoccidioides brasiliensis. The diagnosis was chronic paracoccidioidomycosis (PCM), endemic to Latin America, but challenging to identify in nonendemic regions.<br /><br />PCM, a disease caused by the dimorphic fungus Paracoccidioides brasiliensis, can manifest long after exposure, often following a period in endemic areas. It typically affects the lungs and mucous membranes, causing respiratory symptoms and oral lesions. Misdiagnosis is common, being confused with conditions like tuberculosis or other fungal infections. Diagnosis depends on identifying the causative fungus in tissue samples, commonly confirmed through molecular techniques like PCR.<br /><br />For mild to moderate PCM, azole antifungals such as itraconazole are recommended, while severe cases often require amphotericin B. The patient's chronic PCM likely traced back to his time in Latin America, was treated with itraconazole, leading to symptom improvement. This case underscores the importance of considering travel history in diagnosing PCM and distinguishing it from other conditions with similar clinical presentations.

Keywords

chronic paracoccidioidomycosis

Paracoccidioides brasiliensis

lingual granuloma

mandibular lymphadenopathy

pulmonary nodules

azole antifungals

itraconazole

Latin America

fungal infections

travel history