For the past 5 years, we have been pleased to be able to share interesting cases seen by the participants during the weeks of the year one of our courses is in Session. Each August we run one of our 2-week refresher courses for those with some previous training in tropical medicine. Each case includes a brief history and digital images pertinent to the case. A link to the actual diagnosis and a brief discussion follow.
Epidemiology: Born and has spent his entire life as a forestry worker in the high jungle regions of Peru. Uses tree leaves as toilet paper. Tobacco and marijuana smoker.
Cocaine abuse in the past. No personal history of TB but had an exposure 1 year ago. Physical Examination: Afebrile; oral mucosa clear; absence of an inferior tooth. No significance lymphadenopathy. Crackles in lower lung fields. No visceromegaly. Anal ulcer of 4 x 2 cm with raised borders and granular background, non-tender, no discharge [Image A]. Laboratory Examination: Hematocrit WBC 6, with 62 neutrophils, 22 lymphs, 13 monos, 3 eos, no bands.
Glucose Stools negative for ova and parasites. CXR showed bilateral interstitial and alveolar lesions [Image B]. Sputum AFB negative X3. The differential diagnosis for the lung disease includes: TB, histoplasmosis, lymphoma, cancer and cryptococcosis.
The anal lesion must be differentiated mostly from malignancy. In general, cutaneous or mucosal lesions of paracoccidioidomycosis are painful while those of other infections are not. The lungs are the primary site of infection in paracoccidioidomycosis. The most typical radiographic pattern is bilateral mixed infiltrates alveolar and interstitial , mainly located in the middle and lower lobes.
