Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2018.038
Autopsy and Case Reports
Article / Autopsy Case Report

Disseminated mycosis in a patient with yellow fever

Gustavo Vieira Rodrigues Maciel; Marcelo Combat de Faria Tavares; Leonardo Soares Pereira; Guilherme Lima Castro Silva; Neimy Ramos de Oliveira; Eduardo Paulino Júnior; Marcelo Antonio Pascoal-Xavier

Downloads: 1
Views: 152

Abstract

Disseminated mycosis (DM)—with cardiac involvement and shock—is an unexpected and severe opportunistic infection in patients with yellow fever. DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing. We report the case of a 53-year-old male patient who presented to the emergency department with fever, myalgia, headache, and low back pain. The laboratory investigation revealed a positive molecular test for yellow fever, hepatic injury, and renal failure. During hospitalization, the patient developed hepatic encephalopathy, ascending leukocytosis, and ascites, with signs consistent with peritonitis. On the 11th day of hospitalization, the patient developed atrioventricular block, shock and died. At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.

Keywords

Invasive Fungal Infections, Mycosis, Yellow Fever, Autopsy

References

Minas Gerais. Informe Epidemiológico da Febre Amarela [Internet]. Belo Horizonte: Secretaria de Estado de Saúde; 2018 [cited 2018 May 21]. Vol. 03/04, 3 Abr 2018. Available from: http://www.saude.mg.gov.br/component/gmg/story/10381-informe-epidemiologico-da-febre-amarela-03-04/

Monath TP, Vasconcelos PF. Yellow fever. J. Clin. Virol. 2015;64:160-73. 10.1016/j.jcv.2014.08.030.

Quaresma JA, Pagliari C, Medeiros DB, Duarte MI, Vasconcelos PF. Immunity and immune response, pathology and pathologic changes: progress and challenges in the immunopathology of yellow fever. Rev Med Virol. 2013;23(5):305-18. 10.1002/rmv.1752.23873723

Monath TP, Barrett AD. Pathogenesis and pathophysiology of yellow fever. Adv Virus Res. 2003;60:343-95. 10.1016/S0065-3527(03)60009-6.14689698

Francis TI, Moore DL, Edington GM, Smith JA. A clinicopathological study of human yellow fever. Bull World Health Organ. 1972;46(5):659-67.4538039

Chen Z, Liu L, Lv Y, et al. A fatal yellow fever virus infection in China: description and lessons. Emerg Microbes Infect. 2016;5(7):e69. 10.1038/emi.2016.89.27406389

ter Meulen J, Sakho M, Koulemou K, et al. Activation of the cytokine network and unfavorable outcome in patients with yellow fever. J Infect Dis. 2004;190(10):1821-7. 10.1086/425016.15499539

Best SM, Morris KL, Shannon JG, et al. Inhibition of interferon-stimulated JAK-STAT signaling by a tick-borne flavivirus and identification of NS5 as an interferon antagonist. J Virol. 2005;79(20):12828-39. 10.1128/JVI.79.20.12828-12839.2005.16188985

Laurent-Rolle M, Morrison J, Rajsbaum R, et al. The interferon signaling antagonist function of yellow fever virus NS5 protein is activated by type I interferon. Cell Host Microbe. 2014;16(3):314-27. 10.1016/j.chom.2014.07.015.25211074

Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Nephrol Dial Transplant. 2005;41(5):634-53.16080086

Meis JF, Chakrabarti A. Changing epidemiology of an emerging infection: zygomycosis. Clin. Microbiol. Infect., Suppl. 2009;15(Suppl 5):10-4. 10.1111/j.1469-0691.2009.02973.x.

Valera FC, Lago T, Tamashiro E, Yassuda CC, Silveira F, Anselmo-Lima WT. Prognosis of acute invasive fungal rhinosinusitis related to underlying disease. Int. J. Infect. Dis. 2011;15(12):e841-4. 10.1016/j.ijid.2011.08.005.

Neto FMFD, Camargo PCLB, Costa AN, et al. Fungal infection by Mucorales order in lung transplantation: 4 case reports. Transplant Proc. 2014;46(6):1849-51. 10.1016/j.transproceed.2014.05.033.25131052

Guimaraes LF, Halpern M, Lemos AS, et al. Invasive fungal disease in renal transplant recipients at a Brazilian Center: local epidemiology matters. Transplant Proc. 2016;48(7):2306-9. 10.1016/j.transproceed.2016.06.019.27742285

Hsieh TT, Tseng HK, Sun PL, Wu YH, Chen GS. Disseminated zygomycosis caused by Cunninghamella bertholletiae in patient with hematological malignancy and review of published case reports. Mycopathologia. 2013;175(1-2):99-106. 10.1007/s11046-012-9595-y.23124364

Benbow EW, McMahon RF. Myocardial infarction caused by cardiac disease in disseminated zygomycosis. J Clin Pathol. 1987;40(1):70-4. 10.1136/jcp.40.1.70.3818973

 

 

 

 

 

 

 

5b718bdb0e882578428068a8 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections