The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease

Abstract

The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.

Identification of Paracoccidioides brasiliensis in adrenal glands biopsies of two patients with paracoccidioidomycosis and adrenal insufficiency

“…Such involvement has been minor when the cortisol delta was determined after ACTH administration (14%) or when basal cortisol has been taken as a tool to diagnose adrenal failure 1,2 . Additionally, tomographic, ecographic and nuclear medicine images have revealed subclinical involvement of these glands 5,14 .…”

Hormones and the Resistance of Women to Paracoccidioidomycosis

“…These become enlarged, producing lymph node hypertrophy, hepatomegaly, and splenomegaly. Usually, there is no clinically apparent lung involvement, but image studies have revealed pulmonary abnormalities in all cases (55,103). As its names implies, it is a disease of the young and is diagnosed mainly in undernourished children and adults less than 30 years of age.…”

“…Older classifications subdivided this form into unifocal and multifocal, referring to lesions being present in one or in various organs (43,46). Image and scan studies have revealed that the mycosis is a multiorgan disease regardless of the presence or absence of symptoms related to a particular organ (55,75,103).…”

“…Lung fibrosis is a prominent abnormality (60%) and is regularly accompanied by emphysema and bullae; cavities are also detected (63,73,75,93,96). High-resolution computed chest tomography reveals lesions in the lung periphery and in the posterior aspects, where lesions with ground-glass appearance are observed; nodular lesions that may be small and centrilobular, or large, and cavitating nodules may also be observed (55,75,103). Oral mucosa lesions are regularly observed and localized preferentially in the gums and the hard palate but also in the oropharynx and the larynx.…”

Ulcerated Lesion in Buccal Mucosa in a Patient with Paracoccidioidomycosis—Case Report

“…These become hypertrophic, generating, lymph node enlargement and hepatosplenomegaly. Usually, there is no clinically apparent pulmonary involvement, but imaging studies have revealed pulmonary abnormalities in all cases [17] [18].…”