SEVERE ACUTE PARACOCCIDIOIDOMYCOSIS IN CHILDREN

This report describes clinical and immunologic features of five illust rative cases of paracoccidioidomycosis in previously healthy children. All had disseminated disease and two of them died despite treatment. The major clinical presentation in four patients was fever and diffuse superficial and intraabdominal adenopathy, with or without hepatosple nomegaly. Other sites were also affected: three patients had multiple osteoarticular lesions, occasionally with intense tissue destruction; two had cutaneous eruptions; two had pericardial effusions; and two ha d pulmonary involvement, once considered an organ spared in the young. We detected variable lymphocyte responses to mitogens and to Candida albicans antigen and nonresponsiveness to Paracoccidioides brasiliensi s cell wall antigen. High concentrations of serum immunoglobulins and anti-P. brasiliensis antibodies were present. These immune alterations tended to resolve with treatment, suggesting a reversible nature of t he immune defect. We conclude that this mycosis has a high morbidity a nd mortality in children, which is probably related to an antigen-spec ific immunodeficiency. Further studies are needed to increase knowledg e of this mycosis in children.