Cokeromyces recurvatus in a Papanicolaou test: An exceedingly rare finding that can be mistaken for Paracoccidioides brasiliensis

Abstract

Cokeromyces recurvatus is a zygomycetes yeast form that is very rarely detected in Papanicolaou (Pap) tests, in which it typically represents an innocuous colonizer. Its morphology closely resembles that of the better known Paracoccidioides brasiliensis, which can disseminate widely and cause clinically significant disease. We present a case of C. recurvatus detected in a cervical liquid-based preparation obtained from a 38-year old healthy woman. Careful cytomorphologic evaluation, in combination with culture and molecular techniques, was utilized to make a diagnosis and prevent the misdiagnosis of P. brasiliensis.

Cokeromyces recurvatus: A rare fungus in the Pap test of an asymptomatic woman

“…To date, only 14 cases of C . recurvatus have been reported, 8 (57%) of which involved the female genital tract 3‐7 . Most gynecologic cases were incidentally identified in asymptomatic patients, as in this current case.…”

Multiple Consecutive Cervicovaginal Cytology Specimens Confirm Persistent Colonization by Cokeromyces recurvatus: Case Report and Literature Review

“…Each year in the United States, approximately 50 million cervicovaginal cytology cancer screening tests (Pap tests) are performed. A review of the literature confirms only seven reported cases of C. recurvatus in cervicovaginal cytology specimens; each of these being described in the last 25 years [2][3][4][5][6][7]. In all of the previously reported cases of C. recurvatus from cervicovaginal cytology specimens, no patients have been shown to have invasive fungal disease in the gynecologic tract; however, one pregnant patient with clinical cervicitis attributed to coinfection with C. recurvatus and Candida albicans was successfully treated with antifungal therapy [5].…”

“…P. brasiliensis yeasts have been classically described as having a morphologic "mariner-wheel pattern" in cytologic and histologic preparations. P. brasiliensis is a pathogenic fungus that can induce significant clinical diseases, and it is primarily reported in Central and South America with most cases in Brazil, Columbia, and Venezuela [7]. Though C. recurvatus may display similar morphology to that of P. brasiliensis in cytology slides, the peripheral buds of P. brasiliensis are better described as symmetrically distributed, while the budding of C. recurvatus is classically asymmetrical and patchy.…”

“…Cervicovaginal cytology specimens harboring the yeastlike form of C. recurvatus organisms have been reported in the literature in 7 cases, and 4 of those cases had cultures confirming the fungal organism [2,5,6,7]. When identified outside of the gynecologic tract, C. recurvatus has been known to cause hemorrhagic cystitis in a 72-year-old, diverticulitis in a 9-year-old, and fatal pneumonia in an immunocompromised 27-year-old [8][9][10].…”