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Case Reports
. 2022;46(1):286.
doi: 10.1186/s42269-022-00973-z. Epub 2022 Dec 28.

Systemic paracoccidioidomycosis in a patient with enzymatic myeloperoxidase deficiency and acute lymphoblastic leukemia: case report

Sebastián Hoyos  1 , Cristián Camilo Agudelo  2 , Diana Mercedes Lozano  3 , Luis Eduardo Buitrago  4
Affiliations
Case Reports

Systemic paracoccidioidomycosis in a patient with enzymatic myeloperoxidase deficiency and acute lymphoblastic leukemia: case report

Sebastián Hoyos et al. Bull Natl Res Cent. 2022.

Abstract

Background: Paracoccidioidomycosis is a systemic fungal infection that is potentially fatal, and the most prevalent of its kind in Latin America. The predisposition to infection appears to be related to abnormalities in cellular immunity, given its low prevalence in endemic regions. The role of myeloperoxidase deficiency has not been elucidated.

Case presentation: We present a case of 48-year-old female patient with acute lymphoblastic leukemia, stem cell transplant candidate, who developed a fever with lymphadenopathy and lung nodules, consistent with paracoccidioidomycosis infection, in whom a myeloperoxidase deficiency was later discovered. The treatment of the hematologic malignancy had a good impact solving the enzymatic deficiency and antifungal therapy achieve controlling the infection.

Conclusions: This case lays out the possible association between acute leukemia, an alteration in neutrophil function (needed to fight fungal infections) and an infection due to Paracoccidioides brasiliensis.

Keywords: Acute lymphoblastic leukemia lymphoblastic; Case report; Enzymatic deficiency; Myeloperoxidase deficiency; Paracoccidioidomycosis.

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Conflict of interest statement

Competing interestsWe, the authors declare no competing interests.

Figures

Fig. 1
Fig. 1
High resolution chest computed tomography showing bilateral solid nodules with ground glass halo (arrows). Source: Authors
Fig. 2
Fig. 2
Round, thick-walled conidia, with multibudding yeast cells (“Mickey Mouse ears”), compatible with Paracoccidioides brasiliensis. Grocott’s silver methenamine stain, 40 ×. Source: Authors
Fig. 3
Fig. 3
Epithelioid histiocyte aggregate that constitute a granuloma with central caseating necrosis. H & E, 10 × Source: Authors
Fig. 4
Fig. 4
Bone marrow flow cytometry reveals neutrophils (purple) and monocytes (yellow) lacking expression of cytoplasmic Myeloperoxidase. Eosinophils are depicted in pink, mature T lymphocytes in green (seafome green like), dendritic cells in green (lime green like) and residual T lymphoblast in red. Abbreviations: cyMPO, cytoplasmic Myeloperoxidase; FITC, fluorescein isothiocyanate; SSC-A, side scatter. Source: Authors
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References

    1. Arenas Guzmán R, Torres Guerrero E. Paracoccidioidomicosis. Micol Médica Ilus 6e [Internet] New York: McGraw-Hill Education; 2020.
    1. Catovsky D, Galton DAG, Robinson J. Myeloperoxidase-deficient neutrophils in acute myeloid leukaemia. Scand J Haematol. 2009;9:142–148. doi: 10.1111/j.1600-0609.1972.tb00923.x. - DOI - PubMed
    1. Davies MJ. Myeloperoxidase: mechanisms, reactions and inhibition as a therapeutic strategy in inflammatory diseases. Pharmacol Ther. 2021;218:107685. doi: 10.1016/j.pharmthera.2020.107685. - DOI - PubMed
    1. Domingues-Ferreira M, Levy A, Barros NC, Bertolini DL, de Vasconcelos DM. Case report of myeloperoxidase deficiency associated with disseminated paracoccidioidomycosis and peritoneal tuberculosis. Rev Soc Bras Med Trop. 2017;50:568–570. doi: 10.1590/0037-8682-0462-2016. - DOI - PubMed
    1. Fernanda Reis Gavazzoni Dias M, Mesquita J, Lima Filgueira A, De Souza W. Human neutrophils susceptibility to Paracoccidioides brasiliensis: an ultrastructural and cytochemical assay. Med Mycol. 2008;46:241–249. doi: 10.1080/13693780701824411. - DOI - PubMed

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