C-ANCA POSITIVITY IN A BELGIAN PATIENT WITH PULMONARY PARACOCCIDIOIDOMYCOSIS

We present the case of a 69 yr old, white male, suffering from diffuse interstitial lung disease, finally diagnosed as paracoccidioidomycosi s or South American blastomycosis, During the course of his disease, a ntineutrophil cytoplasmic antibodies (c-ANCAs) became positive, sugges ting the possibility of a Wegener's granulomatosis. Transbronchial bio psies and a video-assisted thoracoscopic lung biopsy revealed only the pulmonary yeast infection, without other co-existing pathology, Durin g treatment with itraconazole, the patient improved clinically and fun ctionally, and c-ANCAs became negative. Serological monitoring confirm ed the diagnosis. To our knowledge, this is the first report describin g positive c-ANCAs in a patient with paracoccidioidomycosis. It re-emp hasizes the fact that cautious interpretation of c-ANCAs in patients w ithout convincing clinical signs or pathological evidence of a granulo matous vasculitis is absolutely necessary, In this era of increased mo bility, a thorough medical history, including documentation of travel, remains an inexpensive tool in making a diagnosis and is still the co rnerstone of good medical practice.