SEVERE JUVENILE TYPE PARACOCCIDIOIDOMYCOSIS IN AN ADULT

Paracoccidioidomycosis has recently been classified into juvenile (acu te) and adult (chronic) forms. The latter affects middle-aged men and causes mucocutaneous lesions, while the more rare juvenile form affect s the reticuloendothelial system of children and adults of both sexes under 30 years of age. It is not yet known, however, if the patient's age has a role in determining the immune response patterns to the fung us and the evolution to one form or the other. We present a 45-year-ol d man who presented with juvenile type disease characterized by intra- abdominal polyadenopathy forming a large epigastric mass. Immune evalu ation showed high titres of anti-Paracoccidioides brasiliensis antibod ies and an antigen-specific cellular immune defect. Treatment resulted in resolution of the clinical and immune abnormalities. His epidemiol ogical background also suggested acute disease: he developed disease a fter moving from an urban to a rural endemic area. We suggest that acu te or juvenile disease may occur in a previously healthy, susceptible individual when moving to an endemic area, at whatever age.