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Tracheoesophageal fistula associated with paracoccidioidomicosis

Antonio Carlos Nogueira, Daniel Soares de Sousa Dantas, Francisco Garcia Soriano, Simone Peres Pilli, João Epalanga Júnior Vidro, Edmar Tafner, Lincoln Tavares de Andrade, Luis Masuo Maruta, Hélio Minamoto, José Pinhata Otoch, João Augusto dos Santos Martines

Abstract


Paracoccidioidomycosis is a systemic fungal disease caused by
Paracoccidioides brasiliensis, agent geographically distributed to certain
areas of Central and South America. The infection by P. brasiliensis has
been reported from north Mexico to south Argentina. Paracoccidioidomycosis
presents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequently
misdiagnosed as malignancy or tuberculosis. The authors present a case
of a 57 year-old man admitted to the hospital due to a chronic consumptive
syndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid and
pyrazinamide 1 year ago without resolution of the simptoms. During the clinical
investigation, pulmonary paracoccidioidomycosis with tracheoesophageal
fistula was diagnosed. The systemic infection was treated with deoxicolate B
amphotericin followed by sulfametoxazole and trimetoprin due to acute renal
function impairment. The fistula was endoscopically treated; inittialy with the
protection of left main bronchus with a tracheal prosthesis followed by the
esophageal fistula’s ostium clipping.

Keywords


Paracoccidioidomycosis; Tracheoesophageal fistula; Prostheses and implants.



DOI: http://dx.doi.org/10.4322/acr.%25y.26065

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