Abstract
Paracoccidioides sp.-Herpes simplex virus (HSV) co-infection was not reported until now and malabsorption syndrome is a rare complication of the acute/subacute form (AF) of paracoccidioidomycosis (PCM), characterized by life-threatening abnormalities, such as fat and protein loss, lymphopenia, ascites, and intense immunosuppression. A 21-year-old woman presented the PCM AF with intense involvement of the abdominal and intestinal lymphoid organs, which leads to the malabsorption syndrome and severe immunosuppression. This patient developed a fatal-disseminated HSV infection associated with the paracoccidioidal disease. This case demonstrates that, in addition to the antigen-specific immunosuppression, some PCM patients can present a generalized cell-mediated immune depression and endogenous infection of latent microorganisms. On the best of our knowledge, this is the first report of an association between PCM and HSV infection.
Highlights
Paracoccidioidomycosis (PCM) is a systemic disease caused by thermally dimorphic fungi of the Paracoccidioides genus that causes a wide range of clinical manifestations (Mendes et al, 2017) and an antigen-specific immunosuppression (Benard et al, 1996a).Paracoccidioidomycosis acute/subacute form (AF) is a less prevalent clinical form, whose symptomatology is characterized by the involvement of the phagocytic-mononuclear system
The literature review showed only two cases of association between an agent of systemic mycosis and Herpes simplex Virus (HSV) infection (Jones et al, 1992; Méndez-Tovar et al, 2012). Both patients were HIV-infected, H. capsulatum was the fungus involved, and the herpetic infection was localized in one patient and disseminated in another
Our case is, to the best of our knowledge, the first report of PCM associated with visceral active HSV infection, in an HIV-negative patient
Summary
Paracoccidioidomycosis (PCM) is a systemic disease caused by thermally dimorphic fungi of the Paracoccidioides genus that causes a wide range of clinical manifestations (Mendes et al, 2017) and an antigen-specific immunosuppression (Benard et al, 1996a). A few patients show the involvement of the abdominal lymphatic system and lymphoid organs, leading to malabsorption syndrome with protein loss, decreased peripheral blood lymphocyte count, chylous ascites, and humoral- and cell-mediated immune suppression (Bettarello et al, 1972; Andrade et al, 1976; Martinez et al, 1979a,b; Troncon et al, 1981). Because of the lack of information about this clinical picture, its diagnosis may delay, the treatment (Fernandes et al, 1988) This case report presents a patient with the AF of PCM with abdominal lymph node enlargement and protein loss associated with a herpetic pneumonitis, a comorbidity not previously reported. The search was performed in EMBASE, CINHAL, COCHRANE, Web of Science, Scopus, and Lilacs until May 2020, using the strategy of malnutrition and similar names or terms AND Herpes simplex infection or similar (Table 1)
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