Presentation
Patient from a rural area, HIV positive and complaining of chest discomfort.
Patient Data
Countless randomly distributed micronodules in a miliary pattern.
Case Discussion
Faced with the context of an HIV-positive patient in an endemic area and with a respiratory complaint of subacute / prolonged evolution, a serological survey was carried out for granulomatous fungal diseases, with a highly reactive result for paracoccidioidomycosis.
Amarican blastomycosis or paracoccidioidomycosis is a systemic granulomatous fungal infectious disease, endemic to tropical or subtropical forests and caused mainly by the fungus Paracoccidioides brasiliensis. Although its most frequent tomographic finding in the lung parenchyma is diffuse interstitial involvement with ground-glass attenuation, sometimes it may manifest primarily with a micronodular pattern. In this case the differential diagnosis includes miliary tuberculosis, histoplasmosis and pulmonary metastases with hematogenous dissemination.
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