Memoria CD.indd - ISHAM

1-17Scintigraphic evaluation of enteric protein loss in patients with activeparacoccidioidomicosisB.L. Griva 1 , R.P. Mendes 2 .1 Nuclear Medicine Service, University Hospital; 2 Tropical Diseases Área. Botucatu Medical School – São Paulo State University.e-mail: tietemendes@terra.com.br (presenting Author)Introduction: The acute subacute form of paracoccidioidomycosis is characterized by intense involvementof organs rich in the phagocytic mononuclear system, such as lymph nodes, spleen, liver and bone marrow.Some of these patients present intense involvement of the abdominal lymphatic system, with protein loss. Thesepatients can also reveal a malabsorption syndrome, becoming severe their prognostic. Methods: Ten patientswith the acute/subacute paracoccidioidomycosis form, confirmed by the identification of typical Paracoccidioidesbrasiliensis yeast forms, were included in this study. Technetium-99m labeled human serum albumin abdominalscintigraphy was performed in all patients. The radiopharmaceutical was prepared according to the manufacturer’sspecifications and the dose administered was 555 MBq IV. A control quality imaging was done immediately afterthe injection using a gamma-camera equipment. Static imaging at 30 min., 1 h, 2 h, 3 h and hourly during theday, if necessary, was performed until the visualization of the presence of radioactivity in the abdominal region.A last imaging was done after 24 h of injection. Two independent nuclear medicine physicians did the qualitativeimaging evaluation. The exam was considered positive of enteric protein loss when radioactivity was seen in anyabdominal imaging with subsequent migration at later images. Results: All the patients presented protein loss inthe 15 exams carried out near the diagnosis and during their follow up. Persistence of protein loss was observedin three patients 3, 5 and 7 years after treatment. Comments: These data show the sensibility of this scintigraphicevaluation and reveal a long period of protein loss in some cases, explaining the delay in their recovery.1-18Biliary ostruction due to acute paracoccidioidomycosis: Analisys of two casesA. S. G. Kono 1 , M. Yoshida. 1 , I. Giarolla 1 , J. Jukemura 2 , G. Benard 1,3 , M. A. Shikanai-Yasuda. 1,41Systemic Mycoses Outpatient Clinic, Division of Infectious Diseases, Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP), Brazil. 2 Division of Clinical Surgery, HCFMUSP, Brazil. 3 Division of Clinical Dermatology, HC FMUSP. Brazil. 4 Department ofInfectious and ParasiticDiseases, FMUSP, Brazil.e-mail: masyasuda@yahoo.com.brParacoccidoidomycosis has been classified in chronic or acute/sub-acute form. The acute/sub-acute form ischaracterized by a rapid course and reticuloendothelial system involvement. In the absence of specific therapy,mortality is high. We describe two cases of acute/sub-acute PCM with abdominal lymphadenopathy and biliaryobstruction.Case 1: A 32 years-old male was hospitalized in 2002 due to fever, cough and weigh loss. He also complainedof abdominal pain. He performed an abdominal CT scan that revealed generalized adenomegaly and hepatomegalyof right lobe. A lymph node biopsy revealed chronic granulomatous inflammation with fungal elements compatiblewith P. brasiliensis. The immunodiffusion test was positive and counterimmunoelectrophoresis titer was 1:512. Hereceived sulfadiazine 6 g/day with improvement. However, he evolved with icterus and increased hepatic functiontests and a progressive hepatomegaly, despite the gradual fall in serology titers during the six years follow-up. Amagnetic resonance performed during this follow-up revealed important dilatation of intra and extra-hepatic biliarytract and hepatomegaly. Nowadays he is on waiting list for surgical intervention.Case 2: A 34 years-old male was hospitalized in 2006 complaining of fever, cervical adenomegaly, abdominalpain and ictericus. He was submitted to a lymph node biopsy that revealed paracoccidioidomycosis. He performedcervical, thoracic and abdominal CT scans that revealed a prominent and generalized adenomegaly. His serologyfor P. brasiliensis was reagent (immunodiffusion) with a counterimmunoelectrophoresis titer of 1:128. Hereceived trimetropim-sulphametoxazole. Patient evolved with important jaundice and increased hepatic functiontests. Another abdominal CT scan revealed biliary compression and common bile duct dilatation. Trimetropimsulphametoxazolewas replaced by amphotericin but the patient presented azotemia and no improvement of thejaundice. The sulfa treatment was re-started and the patient underwent a surgical procedure to decompress thebiliary tract. He evolved with complete total recovery. CT scan performed 6 months later didn’t show adenomegalyor visceromegaly, biliary dilatation. Serology titer fell to 1:8.Conclusions/Discussion: Although clinical treatment is the rule in PCM, clinicians must be aware of thepossibility of compression of the biliary tract. In these situations the surgical procedure can be crucial for therecovery of the patient.149