Fig 1.
(A) Chest tomography from a patient included in this study (case 2) showing peripheral and coalescent ground-glass opacities better seen in the right lung. This 57-year-old male patient was infected by Paracoccidioides sp. in the past, while developing construction activities during 20 years. He was a heavy smoker, developed chronic paracoccidioidomycosis (PCM), and was admitted at our institution presenting a 9-month painful tongue lesion, evolving with emaciation, cervical lymph nodes enlargement, and lung disease. PCM was diagnosed through histopathology from biopsies of the oral lesion and cervical lymph node, which revealed a chronic granulomatous inflammatory process along with multiple budding cells compatible with Paracoccidioides spp. yeast-like cells, better seen in the Grocott’s methenamine silver stain (B). The patient was treated with itraconazole and trimethoprim/sulfamethoxazole for 35 months due to poor adherence. When COVID-19 infection occurred, this patient was under the post-therapeutic follow-up, and presented lung sequelae, such as severe pulmonary fibrosis and chronic obstructive pulmonary disease (COPD). His COVID-19 disease was severe, requiring invasive ventilation, and he died four days after hospitalization.
Table 1.
Summary description of the cohort of patients with paracoccidioidomycosis and COVID-19 co-infection.