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BackgroundDifferential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn’s disease.Case presentationWe report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn’s disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome.ConclusionParacoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.

CONTEXT AND OBJECTIVES: Laparoscopy is a diagnostic method that is currently becoming consolidated for therapeutic use. It consists of endoscopically viewing the abdominal cavity. The aim here was to evaluate the indications for diagnostic videolaparoscopy and the intraoperative findings in an endoscopic gynecology clinic at a tertiary-level hospital over the last five years. DESIGN AND SETTING: Retrospective descriptive study on all diagnostic videolaparoscopy procedures of the last five years carried out in the endoscopic gynecology clinic of a tertiary-level hospital. METHODS:The medical records of 618 women who underwent diagnostic laparoscopy between 2008 and 2012 were analyzed. The clinical characteristics of these women, the indications for videolaparoscopy and the intraoperative findings were evaluated. RESULTS: The women's mean age was 32 ± 6.4 years. Most of the women had already undergone at least one previous operation (60%), which was most frequently a cesarean. The indications for performing videolaparoscopy were infertility in 57%, chronic pelvic pain in 27% and others (intrauterine device, adnexal tumor, ectopic pregnancy or pelvic inflammatory disease) in 16%. The main laparoscopic findings were tubal alterations in the group with infertility (59.78%) and peritoneal alterations in the group with chronic pelvic pain (43.54%). CONCLUSION:The main indications for videolaparoscopy in gynecology were infertility and chronic pelvic pain. However, in most procedures, no abnormalities justifying these complaints were found. RESUMO CONTEXTO E OBJETIVOS:A laparoscopia é um método diagnóstico que atualmente se consolida como terapêutico e se caracteriza pela visão endoscópica da cavidade abdominal. O objetivo foi avaliar as indicações de videolaparoscopia diagnóstica e os achados intraoperatórios no serviço de videolaparoscopia ginecológica de um hospital terciário nos últimos cinco anos. DESENHO E LOCAL: Estudo retrospectivo descritivo com todos os procedimentos videolaparoscó-picos diagnósticos dos últimos cinco anos realizados no serviço de ginecologia endoscópica de um hospital terciário. MÉTODOS: Foram analisados 618 prontuários de mulheres submetidas à laparoscopia diagnóstica entre os anos de 2008 a 2012. Foram avaliadas as características clínicas dessas mulheres, bem como as indicações da videolaparoscopia e os achados intraoperatórios. RESULTADOS: As mulheres tinham em média 32 ± 6.4 anos. A maioria das mulheres já tinha feito pelo menos uma cirurgia anterior (60%), sendo que a mais frequente foi a cesárea. As indicações para a realização da videolaparoscopia foram 57% por infertilidade, 27% por dor pélvica crônica e 16% outras (dispositivo intrauterino, tumor anexial, gravidez ectópica e doença inflamatória pélvica). Os principais achados laparoscópicos foram alterações tubárias no grupo com infertilidade (59.78%) e alterações peritoneais no grupo com dor pélvica (43.54%). CONCLUSÃO: As principais indicações da videolaparoscopia em ginecologia são infertilidade e dor pélvica crônica; mas...

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