Whole-body magnetic resonance imaging for the evaluation of thoracic involvement in disseminated paracoccidioidomycosis

Whole-body magnetic resonance imaging (MRI) is a diagnostic tool that enables the visualization of the entire body and combines fast acquisition times with high contrast resolution. An important advantage of this technique is the absence of ionizing radiation. Thus, whole-body MRI offers a radiation-free alternative to radionuclide imaging and CT for the diagnosis, staging, and monitoring of young patients who require frequent follow-up examinations. Because MRI is the best method to evaluate bone marrow and soft tissues, it represents an ideal tool for the assessment of numerous systemic diseases, especially those affecting the skeletal system. Paracoccidioidomycosis, a systemic fungal disease caused by the fungus Paracoccidioides brasiliensis, is endemic in Central and South America. In Europe and North America, it is considered a rare imported disease, the incidence of which is expected to continue rising due to the increase in migration and international travel. Given that the disease can affect virtually any organ, whole-body MRI seems to be a suitable diagnostic tool for evaluating systemic manifestations of disseminated paracoccidioidomycosis, because it provides a global view. The aim of the present report was to present the whole-body MRI findings of a patient with systemic manifestations of paracoccidioidomycosis, with an emphasis on lymphatic, skeletal, and pleural involvement. To our knowledge, thoracic findings of disseminated paracoccidioidomycosis on whole-body MRI have not been described previously. A 24-year-old man was referred to our facility for the diagnostic investigation of multiple complaints. The symptoms began approximately 15 months prior to hospitalization and mainly consisted of emaciation, fever, painful lymphadenopathy, and crusted, ulcerated skin lesions. The epidemiologic history of the patient revealed that he had worked for the past two years as a farm worker, taking care of animals. Upon physical examination, the patient presented with fever, multiple honey-colored scabs, and ulcerated lesions on the face, trunk, upper limbs, and perianal region. Pulmonary auscultation findings were normal, as were those of the cardiac examination, and there was no abdominal organomegaly. A left cervical lymph node was aspirated, and direct examination for fungi revealed refringent blastoconidia with multiple buds suggestive of P. brasiliensis in the specimen. Blood agar culture was also positive for P. brasiliensis. A skin biopsy specimen stained with Grocott and periodic acid-Schiff stains revealed yeast cells with multiple buds in the form of a ship's wheel, which is a typical finding of P. brasiliensis. Serology by double immunodiffusion techniques was positive for paracoccidioidomycosis. A blood test …