Spontaneous Pneumothorax as an Atypical Presentation of Pulmonary Paracoccidioidomycosis: A Case Report with Emphasis on the Imaging Findings

Abstract

We describe the case of a 45-year-old male with pulmonary paracoccidioidomycosis and spontaneous pneumothorax. The patient presented to the hospital with sudden and intense chest pain accompanied by dyspnea and had a six-month history of dry cough, weight loss, and progressive dyspnea on exertion. Chest X-ray showed a small right pneumothorax, bilateral nonhomogeneous opacities, and emphysematous areas in the lung base. Chest computed tomography showed consolidation in both lungs, with architectural distortion, nodules, interlobular septal thickening, and emphysema, in addition to the right pneumothorax. A lung biopsy revealed yeast consistent with Paracoccidioides brasiliensis. No drainage was needed, and the lung was re-expanded. The patient was treated with antifungal drugs, showed mild improvement, and was referred to outpatient care.

Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis

“…Histoplasma is not the only endemic fungus that has been reported to cause spontaneous pneumothorax. There are case reports of spontaneous pneumothorax being caused by Aspergillus, Paracoccidioides , and Coccidioides species as well [ 9 – 12 ]. Interestingly, most of these case reports involve patients who had pre-existing emphysema or otherwise bullous deformities of the lungs.…”

Pulmonary paracoccidioidomycosis: A case report with high-resolution computed tomography findings

“…Na maioria dos indivíduos os mecanismos naturais de defesa permitem estabelecer um equilíbrio entre o hospedeiro e o agente, permanecendo o fungo viável na forma latente 1,3,4,6 . Entretanto, a doença pode progredir a partir do foco primário pulmonar, mais frequentemente para a pele e mucosas da via aérea e cavidade oral, com formação de lesões granulomatosas ulceradas hemorrágicas 5 .…”

“…Duas formas clínicas foram descritas: A radiografia do tórax na infeção por PB pode apresentar diversas alterações: opacidades lineares e reticulares, nódulos com dimensões variáveis, infiltrados mal definidos, áreas de consolidação do espaço aéreo e cavitação 6 . Este exame apresenta, porém, limitada capacidade na avaliação de doenças pulmonares difusas.…”

Which is your diagnosis?

“…Abnormality of lymph nodes is reported in only 13% of cases, and pleural effusion is uncommon both in acute and chronic presentations of the disease. Pneumothorax secondary to PCM has been reported, probably caused by rupture of an air-containing space (emphysema, either with or without development of bubbles, or cavitary lesion) (15) . Bone involvement in PCM is uncommon and results primarily from hematogenous dissemination of the disease.…”