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Paracoccidioidomycosis (PCM) is caused by Paracoccidioides spp.; during infection, some host mechanisms limit the availability of iron, thereby reducing its reproduction. However, Paracoccidioides spp. can evade the immune defense and, even under limited iron conditions, use this mineral for growth and dissemination. This study evaluated the iron metabolism of 39 patients who were diagnosed with chronic PCM from 2013 to 2021. The forms of iron before treatment and at the time of clinical cure were evaluated based on the following: serum ferritin levels (storage iron); total iron-binding capacity (TIBC) and transferrin saturation (TSAT) level (transport iron); red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), and soluble transferrin receptor (sTfR) levels; and sTfR/log ferritin ratio (functional iron). The mean age of the patients was 54.5 years (±6.7 years). Most patients were men (97.4%), rural workers (92.1%), and smokers (84.6%); furthermore, most had moderate disease severity (66.7%). After achieving clinical cure, we observed that serum ferritin levels decreased, and parameters of functional iron increased. The extent of alteration in these parameters were more pronounced in severe cases than in to mild or moderate cases. Furthermore, moderate correlations were observed between C-reactive protein and the Hb (r = -0.500; p = 0.002), RBC (r = -0.461; p = 0.005), HCT (r = -0.514; p = 0.001), and iron levels (r = -0.491; p = 0.002). However, it is possible to infer that PCM interferes with functional and storage iron because improvements in these parameters after treatment as well as associations with disease severity were observed. PCM can lead to anemia of inflammation, which can be differentiated from iron deficiency anemia by a careful investigation of the iron form parameters.

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Paracoccidioidomycosis, a systemic fungal disease, can lead to dental disorders. As studies on dental problems in patients with paracoccidioidomycosis are few, we evaluated dental disorders and self-perceived oral health in this population.  The objective is to evaluate the oral condition of patients with paracoccidioidomycosis as well as their perception of the problem through a cross-sectional study of 52 adult patients with current or previous paracoccidioidomycosis in a reference hospital in Mato Grosso do Sul between December 2017 and July 2018. Demographic data, dental history, and self-perception of oral health were obtained from the National Oral Health Survey—SB Brazil 2010. The number of permanent decayed, missing, or filled teeth; presence and intensity of gingival bleeding; dental calculus; periodontal pockets; and periodontal attachment loss were recorded. Most patients had chronic paracoccidioidomycosis (n = 50; 96.2%), with involvement of the mouth in the active phase of the disease (n = 38; 73.1%). Participants had a high number of decayed, missing, or filled teeth (median: 30 teeth). The most compromised component was “missing” teeth (median of 21 teeth), and total edentulism was observed in 17 patients (32.7%). Periodontal disease was seen in 15 of 35 patients (43.3%) who had at least one tooth. Regarding satisfaction with their oral health, 27 patients (51.9%) reported being satisfied or very satisfied. There was no association between the degree of satisfaction with the other data. Tooth loss is the major dental problem in patients with paracoccidioidomycosis, and in patients with teeth, periodontal disease was highly prevalent. A general positive self-perception of oral health observed in these patients may reduce their willingness to seek dental treatment.

BACKGROUNDTakayasu's arteritis is a rare disease that mainly affects the aorta and its main branches in the form of vascular occlusion. The patient may also present with aortic regurgitation, aneurysm of the aorta or its branches and secondary arterial hypertension. About 13% of patients develop ocular ischemic syndrome which is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. CASE REPORTA 39-year-old female patient diagnosed with Takayasu's arteritis in 2013. She underwent pulse therapy with cyclophosphamide and methylprednisolone at diagnosis. Maintenance was done with prednisone and methotrexate (MTX). She underwent left internal carotid artery angioplasty in 2014. New pulse therapy regimen with cyclophosphamide 1.2 g/month for 1 year in 2015, due to disease activity (carotid artery restenosis). Maintenance started again with MTX until 2017, when she lost follow-up. She resumed in 2018, during pregnancy, having used prednisone alone. In June 2019, infliximab was started and she continued on this treatment until July 2021. Treatment was switched to tocilizumab in August 2021. Nevertheless, her desease maintained an aggressive evolution with bilateral occlusion of internal carotids and basilar artery. She evolved with bilateral amaurosis and optic nerve atrophy (ischemic neuritis) in addition to low ocular pressure (2 mmHg) due to ischemia of the ciliary body, characterizing ischemic ocular syndrome caused by the disease. CONCLUSIONTakayasu's arteritis is a rare disease that mainly affects young women. Although the initial symptoms are nonspecific, early treatment is of paramount importance to avoid severe forms of the disease, such as the patient described above, who developed several complications, including ocular ischemia and stenosis of the carotid and basilar arteries.