Paracoccidioidomycosis brasiliensis. Case report of female genital involvement

Resumen

Paracoccidioidomycosis is a systemic disease that predominantly affects males. Experimental models suggest that males are more susceptible to the disseminated form of the disease. In vitro studies have documented growth inhibition in the presence of estradiol and progesterone whereas testosterone does not. Paracoccidioidomycosis has been "well described involving the male genitalia. Female genital involvement is rare; perhaps related to hormonal inhibition of fungal growth. A 57 year-old causasian female is described who presented with a ten year history of diffuse abdominal pain with alternating diarrhea and. constipation. She went on to present with an acute surgical abdomen and proceeded to laparotomy. Histopathological study revealed involvement of the omentum, fallopian tubes and right ovary with Paracoccidioidomycosis. Endometrial biopsy revealed chronic granulomatous endometritis, however, no fungus was visualized. Chest X ray and tomography were consistent with right parahilar involvement. We suggest, pathophysiologically, that the genital disease represents reactivation of an abdominal focus.