Psoas Abscesses Caused by Paracoccidioides brasiliensis in an Adolescent

• DOI: 10.1007/s11046-008-9152-x
• Publication Date: 2008-09-09T09:42:07Z
• Authors: Mariana Tresoldi ...; Bruno Livani; William Dias Bela...; Antonia Teresinha...; Ricardo Mendes Pe...
• Keywords: Male; 0301 basic medicine; 0303 health sciences; Antifungal Agents; Adolescent; Fever; Paracoccidioides; Directly Observed Therapy; 3. Good health; Radiography; 03 medical and health sciences; Amphotericin B; Trimethoprim, Sulfamethoxazole Drug Combination; Humans; Patient Compliance; Psoas Abscess; Lymph Nodes; Itraconazole; Paracoccidioidomycosis; Child; Infusions, Intravenous

In order to describe the case of an adolescent who developed psoas abscesses caused by Paracoccidiodes brasiliensis.A 12-year-old boy was admitted with a history of daily fever and global lymph nodes enlargement. He had been treated in the last 6 years, with irregular use of the drugs, for an acute form of paracoccidioidomycosis (PCM). He presented a tenderness fluctuating polyadenopathy in all cervical, submandibular, supraclavicular, axillary, and inguinal chains; several lymph nodes were up to 4 cm in diameter, hardened and coalescent. After 1 month of unsuccessful therapy with SMX-TMP, the patient presented a pain in the right groin and difficulty to walk. CT scan showed a global retroperitoneal lymph nodes enlargement, some with central necrosis and two bigger collections adjacent to both psoas muscles. A surgical drainage of the collections was performed for several times. The patient received a total of 1.9 g of Amphotericin B. After 1 month of the last surgical procedure, CT scan showed only a residual collection, and the patient was sent to ambulatory follow-up. We hypothesed that the retroperitoneal lymph nodes became a coalescent mass that fistulized to the psoas compartment.The patient presented a febrile lymphoproliferative syndrome that is frequently seen in children with PCM. Although a polymorphic manifestation is observed in this disease, psoas abscess is a rare complication of PCM. The health professionals that take care of the patients with PCM must pay attention to the possibility of this one more complication.