Paracoccidioidomycosis at Autopsy: A Case Series and Literature Review.

Abstract

The prevalence of paracoccidioidomycosis remains unknown; current estimates rely primarily on hospital-based records from Brazil, where approximately 80% of reported cases occur. In Brazil, paracoccidioidomycosis ranks as the eighth leading cause of death among chronic infectious diseases. To present data on cases of paracoccidioidomycosis identified at autopsy in a teaching hospital and to compare these findings with previously published autopsy case series. Autopsy records from 1989 to 2024 were reviewed to identify paracoccidioidomycosis cases. Demographic, epidemiologic, and clinical data were extracted from the corresponding medical charts. Among 2397 autopsies, 17 cases of paracoccidioidomycosis (0.71%) were confirmed. Twelve patients (70.5%) were male, with a median age of 44.6 years. Nine patients (52.9%) were HIV (human immunodeficiency virus)-positive, 5 of whom (55.5%) received both diagnoses within the same year. Including the present study, 12 published autopsy case series of paracoccidioidomycosis have summarized the findings from 325 cases. Most cases demonstrated disseminated fungal disease involving multiple organs, with frequencies ranging from 42.8% to 100% for the lungs; 28.5% to 100% for lymph nodes; 17.6% to 83.3% for mucosal sites; 11.8% to 80.5% for the adrenal glands; and 2.8% to 64.3% for the skin. This study, consistent with other autopsy series, confirms the systemic nature of this mycosis, particularly in HIV-infected patients. HIV infection appears to alter the natural history of paracoccidioidomycosis, resulting in a more acute, severe, and disseminated clinical course. All non-HIV-infected patients were diagnosed post mortem and had less extensive systemic organ involvement. The HIV-infected cases herein included represent the largest autopsy cohort of HIV-paracoccidioidomycosis coinfection reported to date.