COVID-19 and acute juvenile paracoccidioidomycosis coinfection

Case presentation A 19-year-old male patient was admitted to the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, on 10 March 2020 complaining of an 8-month history of progressive weight loss; multiple cervical, axillary, and inguinal lymph node enlargements; abdominal distension; and disseminated cutaneous lesions (Fig 1). Ulcerated skin lesions covered by crusts on the patient’s face and scalp. https://doi.org/10.1371/journal.pntd.0008559.g001 A histopathological examination of the left inguinal lymph node revealed chronic granulomatous lymphadenitis with the presence of multiple budding fungal structures typical of Paracoccidioides spp. in silver staining. Because he presented an important left inguinal lymph node enlargement with fluctuation, its content was aspirated for relief and diagnostic confirmation. Real-time reverse-transcription PCR (RT-PCR) (Biomanguinhos kit [E+P1], Fiocruz, Brazil) of nasopharyngeal secretion and bronchoalveolar fluid tested positive for severe acute respiratory syndrome–related coronavirus 2 (SARS-CoV-2). In the chronic PCM form, frequent tobacco abuse, chronic obstructive pulmonary disease, and pulmonary alterations caused by the infection lead to tissue fibrosis, justifying this increased risk.