PMC9157441_01
Presence of acid-alcohol-fast bacilli in the lymph node, Zielh Nielsen staining, 40X (A). Child's chest showing multiple lymphadenopathy in the cervical and thoracic region, also cachexia and use of accessory muscles for breathing (B).
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The patient underwent a cervical lymphadenopathy biopsy showing multinucleated giant cells and the presence of positive acid fast bacilli in the Zielh Nielsen stain (Fig. 1), for which he began anti-tuberculosis treatment with rifampicin, isoniazid, ethambutol and pyrazinamide with clinical improvement and a decrease in fever for which he was discharged from the hospital.
Presence of yeasts with multiple budding on the ship's rudder, Periodic Acid-Schiff staining - PAS - 40X, (A). Presence of multiple budding yeasts, Gomori Grocott stain - 40X (B).
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Three weeks after starting treatment for tuberculosis, the patient returned with generalized lymphadenopathy, fever, abdominal distension, lethargy, poor oral intake, cough with whitish sputum and dyspnea at rest, was noted to be tachycardic (heart rate of 119 beats per minute), tachypnoeic (respiratory rate of 28 breaths per minute) (Fig. 2), and had an oxygen saturation of 88% under room air. Biopsy of the right cervical lymph node and of the thoracic region was performed, the histological study revealed presence of yeasts with multiple budding in ship's rudder compatible with paracoccidioidomycosis in both lymph node tissues (Fig. 2), therefore, the patient was treated as a case of disseminated CPM with secondary TB.