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

• Autores: Quispe, Jose, Chambi, Liliana, Azañero-Haro, Johan, Soto, Alonso
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Universidad de San Martín de Porres
• Repositorio: Horizonte médico
• Lenguaje: español
• OAI Identifier: oai:horizontemedico.usmp.edu.pe:article/3239
• Enlace del recurso: https://www.horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/3239
• Nivel de acceso: acceso abierto
• Materia: Paracoccidioidomycosis; Human T-lymphotropic virus 1; Coinfection; Paracoccidioidomicosis; Virus Linfotrópico T Tipo 1 Humano; Coinfección

Paracoccidioidomycosis is a systemic mycosis, endemic to Latin America, caused by the dimorphicfungus Paracoccidioides spp., mainly acquired through the inhalation of spores present in theenvironment. It predominantly affects males in rural areas due to their frequent exposure tocontaminated soil. Following primary infection, the pathogen has the potential to spread viahematogenous or lymphatic routes, involving various organs and systems. The acute form ofparacoccidioidomycosis 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 includeprior immunosuppression and infectious comorbidities, such as retroviral coinfections. We presentthe case of a 68-year-old male with chronic disseminated paracoccidioidomycosis and HTLV-1coinfection. The patient exhibited mucocutaneous lesions, extensive pulmonary involvementand significant adrenal impairment, indicating the invasive capacity of Paracoccidioides spp.and the adverse impact of coinfection on immunity. Initial treatment with amphotericin B wasadministered; 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 ofconsidering coinfections, such as HTLV-1, which can modify the clinical course, worsen the prognosis and increase mortality in these complex diseases.