Paracoccidioidomycosis in an Elderly Simulating Cholangiocarcinoma

Keywords: Cholangiocarcinoma, Paracoccidioidomycosis


Paracoccidioidomycosis, the most prevalent deep mycosis in Latin America, is caused by dimorphic species of the genus Paracoccidioides, affects predominantly male rural workers between 30-50 years of age and is an important cause of morbidity and mortality. It can present in two clinical forms: acute/subacute or chronic. In rare cases paracoccidioidomycosis may simulate neoplasia and must be considered as a differential diagnosis of intra-abdominal tumors in endemic areas. We report an exuberant case of subacute paracoccidioidomycosis in an elderly lady, although it is more frequent in the juvenile form. Multiple facial skin lesions were associated with a wasting syndrome and extensive adenopathy including in the hepatic area, causing bile duct dilatation simulating a cholangiocarcinoma. Skin histopathology was diagnostic and antifungal treatment allowed complete resolution of cutaneous and systemic lesions, thus highlighting the merit of the dermatologist, who was fundamental for the conclusive diagnosis and institution of specific therapy, resulting in a favorable outcome.


Download data is not yet available.


Rocha-Silva F, Guimarães CF, de Oliveira Júnior ER, de Figueiredo SM, Caligiorne RB. Disseminated paracoccidioidomycosis prediagnosticated as neoplasm: An important challenge in diagnosis using rt-PCR. Med Mycol Case Rep. 2017;19:1-5. doi: 10.1016/j.mmcr.2017.09.003.

de Macedo PM, Almeida-Paes R, Freitas DF, Varon AG, Paixão AG, Romão AR, et al. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis. 2017;11(3):e0005500. doi: 10.1371/journal.pntd.0005500.

Prohmann CM, Dantas CA, e Silva LB, Gatti RF, Machado TM, Antônio JR. Paracoccidioidomycosis with Lymphonodal and Mucous Involvement - Case Report. SPDV. 2017;75(3):283-7. doi: 10.29021/spdv.75.3.818.

Steinbrück K, Fernandes R. Biliary Paracoccidioidomycosis: An Unusual Infection Simulating Malignant Neoplasm. Ann Hepatol. 2019;18(1):258-262. doi: 10.5604/01.3001.0012.7935.

Steinbrück K, Fernandes R, Campos CF, Bento G, Stoduto G, Auel T. Intrahepatic biliary paracoccidioidomycosis mimicking cholangiocarcinoma. J Gastrointestin Liver Dis. 2014; 23(3):239. doi: 10.15403/jgld.2014.1121.233.ksk.

Bernardes Filho F, Sgarbi I, Flávia da Silva Domingos S, Sampaio RCR, Queiroz RM, Fonseca SNS, et al. Acute paracoccidioidomycosis with duodenal and cutaneous involvement and obstructive jaundice. Med Mycol Case Rep. 2018;20:21-25. doi: 10.1016/j.mmcr.2018.01.005.

Góes AM, Silva LSS, Araújo SA, da Cruz SG, Siqueira WC, Pedroso ERP. Paracoccidioidomycosis disease (Lutz-Splendore-Almeida): etiology, epidemiology, and pathogenesis. Rev Med Minas Gerais. 2014;24(1):58-63. doi: 10.5935/2238-3182.20140009.

Shikanai-Yasuda MA, et al. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev. Soc. Bras. Med. Trop. 2017;50(5):715-740. doi: 10.1590/0037-8682-0230-2017.

Fortes MRP, Miot HA, Kurokawa CS, Marques MEA, Marques SA. Immunology of paracoccidioidomycosis. An. Bras. Dermatol. 2011;86(3):516-524. doi: 10.1590/s0365-05962011000300014.

Ferreira Rocha L, de Araújo Torres D. Acute Paracoccidioidomycosis in a 40-Year-Old Man: A Case Report and Literature Review. Mycopathologia. 2017;182(11-12):1095-1099. doi: 10.1007/s11046-017-0196-7.

Marques SA. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating. An Bras Dermatol. 2013;88(5):700-11. doi: 10.1590/abd1806-4841.20132463.

Marques SA, Lastória JC, Camargo RM, Marques ME. Paracoccidioidomycosis: acute-subacute clinical form, juvenile type. An Bras Dermatol. 2016;91(3):384-6. doi: 10.1590/abd1806-4841.20164953.

Lima TB, Domingues MA, Caramori CA, Silva GF, Oliveira CV, Yamashiro FDS, et al. Pancreatic paracoccidioidomycosis simulating malignant neoplasia: case report. World J Gastroenterol. 2013;19(34):5750-3. doi: 10.3748/wjg.v19.i34.5750.

Prado FL, Prado R, Gontijo CC, Freitas RM, Pereira MC, Paula IB, et al. Lymphoabdominal paracoccidioidomycosis simulating primary neoplasia of the biliary tract. Mycopathologia. 2005;160(1):25-8. doi: 10.1007/s11046-005-2670-x.

Elder DE. Lever's Histopathology of the Skin. 11th ed. Philadelphia: Wolters Kluwer Health, 2014.

Neves AR, Mamoni RL, Rossi CL, de Camargo ZP, Blotta MH. Negative immunodiffusion test results obtained with sera of paracoccidioidomycosis patients may be related to low-avidity immunoglobulin G2 antibodies directed against carbohydrate epitopes. Clin Diagn Lab Immunol. 2003;10(5):802-807. doi: 10.1128/CDLI.10.5.802-807.2003.

How to Cite
Guerra, I., L. P. Simões, H., F. Valle, A., & C. M. N. Castañon, M. (2021). Paracoccidioidomycosis in an Elderly Simulating Cholangiocarcinoma. Journal of the Portuguese Society of Dermatology and Venereology, 79(3), 273-277.
Case Reports