Paracoccidioidomycosis and HTLV-1 infection: incidental coexistence? A case report

Abstract

Paracoccidioidomycosis is a systemic mycosis, endemic to Latin America, caused by the dimorphic
fungus Paracoccidioides spp., mainly acquired through the inhalation of spores present in the
environment. It predominantly affects males in rural areas due to their frequent exposure to
contaminated soil. Following primary infection, the pathogen has the potential to spread via
hematogenous or lymphatic routes, involving various organs and systems. The acute form of
paracoccidioidomycosis impairs peripheral T-cell function and disrupts neutrophil maturation,
while the chronic form is characterized by a progressive decline of the cellular immune response,
along with increased Th1-cytokine levels. Severe cases may present with hypergammaglobulinemia,
reduced phagocytic capacity and immune dysregulation. The most significant risk factors include
prior immunosuppression and infectious comorbidities, such as retroviral coinfections. We present
the case of a 68-year-old male with chronic disseminated paracoccidioidomycosis and HTLV-1
coinfection. The patient exhibited mucocutaneous lesions, extensive pulmonary involvement
and significant adrenal impairment, indicating the invasive capacity of Paracoccidioides spp.
and the adverse impact of coinfection on immunity. Initial treatment with amphotericin B was
administered; however, the patient developed multiple organ failure, resulting in a fatal outcome.
This case highlights the need for a comprehensive approach to the diagnosis and treatment of disseminated mycoses in immunocompromised patients, particularly in endemic regions. It also emphasizes the importance of
considering coinfections, such as HTLV-1, which can modify the clinical course, worsen the prognosis and increase mortality in these complex diseases.