Prostatic paracoccidioidomycosis: differential diagnosis of prostate cancer

Abstract

Symptomatic prostatic paracoccidioidomycosis (PCM) is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.Key words: Paracoccidioides brasiliensis -paracoccidioidomycosis -prostatitis -prostate cancer Paracoccidioidomycosis (PCM) is an important deep mycosis in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis, whose spores enter the body via the respiratory tract and evolve either asymptomatically or in a sub-acute or chronic manner. The parasite is able to provoke several clinical presentations due to its capacity to disseminate itself from the lungs through the lymphatic system or via the blood stream to any organ or system. PCM mainly affects adult males, preferentially in the lungs, mucosa, skin and phagocytic-monocytic system (Paniago et al. 2003. On a smaller scale, it reaches the nervous, musculoskeletal and suprarenal systems (Paniago et al. 2003). Its clinical incidence in the urinary tract, especially in prostatic injuries, is not well known. In a few necropsy studies involving disseminated PCM cases, its incidence varies from 2.7-9% (Salfelder et al. 1969, Begliomini et al. 1993.Prostatic diseases have become more common due to the increase in the population's age. Generally, they appear in males over 40-years-old, being more often bacterial and viral infections, benign hyperplasia and adenocarcinoma. Prostatic adenocarcinoma is the most fearful lesion due to its malignant and metastatic potential, and it is seen clinically in 10% of cases. Its diagnosis must always be set apart because its mortality is 3%, making it the greatest cause of morbi-mortality among men (Crawford 2003).Fungal prostatitis is unusual, having as its most common agents Coccidioides immitis, Candida albicans, Aspergillus sp., Cryptococcus neoformans and Blastomyces dermatitidis, which mainly affect patients who are immune-suppressed. The symptomatic attack of the prostate by PCM has rarely been described. Its potential severity justifies the reporting of this case. In this paper, infection of the prostate by P. brasiliensis is described, mimicking cancer with urethral obstruction and urgent expansion of the bladder. Case studyAAF, a 54-year-old married rural worker who was born in and is a current resident of São Sebastião do Maranhão, Minas Gerais, Brazil, presented in December 2003 with palate stomatitis associated with dysphagia and odynophagia. A biopsy of this injury revealed P. brasiliensis. He was treated with Sulfametoxazol (800 mg) and Trimethoprim (160 mg) daily in an irregular way for 20 months. In December 2004, he started to complain of dysuria, polyuria and urinary urgency and frequency, which culminated after one year in prompt urinary retention. Concomitantly, a stomatitis with moriforme injury of the palate appeared.A digital r...

Paracoccidioidomicose Infra-Epiglote Como Diagnóstico Diferencial De Câncer De Laringe: Relato De Caso.

“…A PCM aparece em outros estudos como diagnóstico diferencial para neoplasias, visto que possui diversas manifestações ainda pouco conhecidas na literatura, como na próstata e pâncreas (LOPES et al, 2009;LIMA et al, 2013).…”

Epidemiology, Clinical, and Therapeutic Aspects of Paracoccidioidomycosis

“…All of them presented with lesions in the external genitalia and only one was a female patient, who had the juvenile PCM form [52•]. Lopes et al [53] described a case of PCM confused with prostatic adenocarcinoma in a 54-year-old man who had manifested palate stomatitis associated with odynophagia and dysphagia 5 years before. The patient also had dysuria, polyuria, urinary urgency, and, finally, urethral obstruction.…”

“…The patient also had dysuria, polyuria, urinary urgency, and, finally, urethral obstruction. Histological analysis revealed a diffuse chronic granulomatous inflammatory process and typical Paracoccidioides yeasts with multiple sprouting [53].…”

Fundamentals of paracoccidioidomycosis treatment

“…However, according to survey data, the combination sulfamethoxazole-trimethoprim has been the most used for treating patients with PCM, achieving great success in healing (Table 1). In severe forms of the disease, the treatment regimen involves administration of an IV solution of Cotrimazole (sulfamethoxazole 400 mg/ trimethoprim 80 mg), 2 ampoules/8 hr until clinical improvement of the patient followed by administration of oral antifungal drugs [Deps et al, 2004;Lopes et al, 2009;Ministé rio da Saú de, 2009a]. In less severe forms of the disease, the latter should be administered for a period of 2 years, resulting in high dropout rates during treatment (Table 2).…”