CHEST Guidelines-Exclusively-Tracheobronchial-Paracoccidioidomycosi

Exclusively-Tracheobronchial-Paracoccidioidomycosi

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This document reports a rare medical case of Paracoccidioidomycosis (PCM), a systemic granulomatous mycosis most prevalent in South America, manifesting exclusively in the tracheobronchial region. Typically, PCM affects the lungs among other parts of the body. However, there hadn't been previous reports of it being confined solely to the tracheobronchial tree without pulmonary involvement.<br /><br />The case involved a 76-year-old former farmer who had been experiencing persistent symptoms like fever, weight loss, and significant cough with purulent secretions for a year. Despite extensive medical history including smoking, diabetes, and respiratory conditions, the patient's initial treatments with various antibiotics provided only partial and temporary relief.<br /><br />A high-resolution CT scan and subsequent bronchoscopy revealed significantly thickened and irregular tracheal walls and substantial tracheal stenosis. Tracheal biopsy highlighted tissue infiltration by the fungus Paracoccidioides brasiliensis through Grocott-Gomori silver methenamine staining. Following this diagnosis, cultures confirmed the presence of the fungus after 20 days. Treatments with itraconazole over nine months yielded significant improvements across clinical, laboratory, and radiological parameters.<br /><br />The study found that while PCM is a common mycosis in Latin America, it’s rare to find cases with respiratory tract involvement limited to the tracheobronchial areas, differentiating it from the more common instances which involve other pulmonary areas. The report emphasizes the importance of differential diagnosis and the potential for airway involvement that could lead to critical respiratory obstructions, advocating for awareness and early detection to prevent serious complications.

Keywords

Paracoccidioidomycosis

tracheobronchial

systemic mycosis

Paracoccidioides brasiliensis

tracheal stenosis

itraconazole treatment

differential diagnosis

respiratory obstructions

Grocott-Gomori staining

South America