Paracoccidioidomicosis e infección por HTLV-1: ¿coexistencia incidental? Reporte de un caso

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.