Images in Clinical Tropical Medicine: Acute-Subacute Paracoccidioidomycosis

Abstract

A 29-year-old male farmer from Yambrasbamba, Amazonas, in the Amazon rainforest in Peru presented with a 4-month history of cervical lymphadenopathy, persistent fever, jaundice, weight loss, abdominal pain, and malaise. Physical examination revealed multiple mobile and painless lymph nodes in the submental, submandibular, and cervical chains (Figure 1A). Jaundice and hepatosplenomegaly were present. Laboratory tests showed microcytic hypochromic anemia (hemoglobin: 9 g/dL), leukocytosis (15,600 cells/mm3) with lymphocytosis (neutrophils 35.8%, eosinophils 0.5%, basophils 0.8%, monocytes 2.2%, and lymphocytes 60.7%), elevated alkaline phosphatase (1,177 U/L), and elevated total bilirubin (14 mg/dL; direct bilirubin 12.6 mg/dL). Serologies for HIV, human T-lymphotropic virus-1, syphilis, hepatitis C, and hepatitis B were negative. A chest computed tomography (CT) scan revealed cervical and axillary lymphadenopathy without pulmonary involvement (Figure 1B).