Abstract：
BACKGROUND: Paracoccidioidomycosis is a neglected tropical disease caused by fungi of the genus Paracoccidioides. A wide range of symptoms is related to the disease; however, lungs and skin are the sites predominantly affected. The disease is mostly seen in people living in rural areas in Latin America.
METHODS: We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological Paracoccidioides antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge.
CONCLUSIONS: Due to the intense inflammatory response triggered by Paracoccidioides cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.
METHODS: We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological Paracoccidioides antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge.
CONCLUSIONS: Due to the intense inflammatory response triggered by Paracoccidioides cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.
摘要：
背景：副孢子菌病是一种被忽视的热带病，由副孢子菌属真菌引起。广泛的症状与疾病有关;然而，肺和皮肤是主要受影响的部位。这种疾病主要见于生活在拉丁美洲农村地区的人们。
方法：我们介绍了一例对抗真菌治疗反应缓慢的严重播散性副病菌的儿科病例。三个月内,症状演变成肝脾肿大，坏死的颈部和腹部淋巴结，和脾脓肿。两性霉素B脱氧胆酸盐和伊曲康唑的临床反应缓慢，导致胸膜和腹膜腔积液，心力衰竭和休克。两性霉素B脱氧胆酸被脂质体制剂取代，没有回应。随后，治疗中加入了泼尼松，这导致了临床反应的改善。血清学副球菌抗体滴度不典型，在关键阶段滴度非常低，在恢复期显着增加。最终用两性霉素B脱氧胆酸盐清除了感染，脂质体两性霉素B和皮质类固醇的使用。副孢子菌病血清学在出院后两年无反应性。
结论：由于副球菌细胞引发的强烈炎症反应，短时间给予小剂量泼尼松可调节炎症反应并支持抗真菌治疗.
方法：我们介绍了一例对抗真菌治疗反应缓慢的严重播散性副病菌的儿科病例。三个月内,症状演变成肝脾肿大，坏死的颈部和腹部淋巴结，和脾脓肿。两性霉素B脱氧胆酸盐和伊曲康唑的临床反应缓慢，导致胸膜和腹膜腔积液，心力衰竭和休克。两性霉素B脱氧胆酸被脂质体制剂取代，没有回应。随后，治疗中加入了泼尼松，这导致了临床反应的改善。血清学副球菌抗体滴度不典型，在关键阶段滴度非常低，在恢复期显着增加。最终用两性霉素B脱氧胆酸盐清除了感染，脂质体两性霉素B和皮质类固醇的使用。副孢子菌病血清学在出院后两年无反应性。
结论：由于副球菌细胞引发的强烈炎症反应，短时间给予小剂量泼尼松可调节炎症反应并支持抗真菌治疗.
