Lesões pulmonares observadas na paracoccidioidomicose (pbmicose) pela radiologia foram designadas: leve, moderada e grave de acordo com critério estabelecido pelos autores. Lesões infiltrativas intersticiais bilaterais nddulo fibrolineares e cotonosas foram identificadas respectivamente em 34 e em 23 doentes. Formas leve, moderada e grave assinaladas respectivamente em 6 10 e 19 mostraram à análise radiológica evolutiva melhora em 2, piora em 15 e manutenção do padrão da lesão em 18 doentes. Testes de função pulmonar realizados nos doentes durante o retorno ambulatorial evidenciaram: 12 com padrão espirográfico normal, 20 obstrutivos e 3 mistos; 34 doentes estavam hiperventilando e todos apresentaram aumento da diferença alvéolo arterial. Os resultados obtidos permitiram supor que a fibrose residual descrita nos padrões radiológicos; manutenção e piora de 33 deles aliada à doença obstrutiva crônica verificada pelas provas de função pulmonar constituíram subsídios para o desenvolvimento do Cor pulmonale assinalado

Pulmonary function in follow-up of 35 patients with paracoccidioidomycosis (South American Blastomycosis) Pulmonary lesions observed in pbmycosis were denominated: mild, moderate and severe according to the criteria established from radiolgical findings by the authors. Bilateral nodulofibrolinear and cotton interstitials infiltrates were identified respectivelly on 34 and 23 patients. Later radiological analyses showed mild, moderate and severe pulmonary lesions respectivilly in 6; 10 and 19 evolving to improved in 2; worsened in 15 and maintained in 18 patients. Normal spirographic test in 12; obstructive defect in 20; mixed in 3; hyperventilation in 34 and alveolar arterial difference increased in all patients. Residual fibrosis observed in radiological maintained and worsened of 33 themes added to chronic obstructive pulmonary disease recognized by lung function tests both were able to explain the development of Cor pulmonale syndrome in 6 patients.

A paracoccidioidomicose (Pbmicose) atinge os pulmões pela via inalatória, onde se estabelece o complexo primário semelhante ao da tuberculose. A traquéia comprometida pela via tubohemolinfática desenvolveria reação inflamatória em processo granulomatoso levando à obstrução estenosante com asíixia. Acompanhou-se um doente, masculino, 32 anos, branco, natural de Sarutaiá (SP), lavrador, que há 8 meses desenvolveu tosse expectorativa branco-amarelada, diária, sem fatores de melhora ou piora e dispnéia inicial discreta. Há 4 meses, anorexia, fraqueza e astenia. Há 1 mês a dispneia se agravou. Perdeu 15 kg. Tabagista e etilista há 16 anos. Exame físico revelou: PA — 10/7 mmHg, FR = 28 bpm, peso 31 kg, hipocratismo digital e hipotrofia muscular Tórax enfisematoso e síndrome obstrutivo aos testes de função pulmonar. Coração: P2 desdobrada e hiperfonética. Hepatesplenomegalia. Desenvolveu cor-pulmonale e insuficiência adrenal à internação, evoluindo após 45 dias para óbito em insuficiência respiratória aguda asfixiante, apesar da terapia antifúngica ter sido completa. A literatura médica revista não mostrou registro de caso semelhante de cor-pulmonale e insuficiência adrenal de evolução subaguda.

Paracoccidioidomycosis (Pbmycosis) reaches the lungs through the respiratory tract where it initiates the primary infection. Although the disease produces a variety of extrapulmonary manifestations, the lungs are involved in a large number of cases. The trachea is affected by Pbmycosis lymphohematogenic dissemination causing a granulomatous process leading to airway obstruction and secondary asphyxia. A 32 years old male, farm worker coming from Sarutaia (SP.) was studied in our hospital. The patient has developed, since 8 months ago a white productive daily cough and a mild dyspnea. Four months later, the mentioned symptoms worsened and anorexia and asthenia appeared. One month previously to hospital admission the dyspnea increased and a weight loss of 15 kg was observed. He has been a heavy smoker and a heavy drinker during the last 16 years. On physical examination it was observed: blood pressure = 100/70 mm/Hg, respiratory rate = 28 pm, body weight = 31 Kg. Pulmonary emphysema, clubbing, loud an splitting S2, right ventricular hypertrophy on E.K.G., hepatosplenomegaly and signs of obstructive pulmonary disease allowed the diagnosis of a "Cor pulmonale" — like syndrome, Amphotericin B was administred at the dose of 1 mg/Kg body weight. A relative adrenal insufficiency was observed early during the treatment. 45 days after hospitalization the patient developed an acute respiratory insufficiency caused by tracheal obstruction and aggravated Cor pulmonale. In spite of intensive care he died. The tracheal stenosis and sub acute Cor pulmonale reported in this patient is a rare manifestation of human pulmonary pbmycosis.

A paracoccidioidomicose é doença sistêmica que atinge mais o sexo masculino do que o feminino. Modelos experimentais mostram maior sensibilidade dos machos do que as fêmeas à dsseminação da doença. A literatura médica é rica em relatos de casos de Pbmicose do trato genital masculino. A raridade da Pbmicose sistêmica na mulher devido à ação hormonal tornou inusitada a descrição de um caso com envolvimneto genital. Paciente de 57 anos, branca, procedente de Conchas (SP), queixando-se de dor abdominal há 10 anos, difusa, seguida de eólica periumbelical periódica, com diarréia e obstipação alternadas. Piorou desse quadro e evoluiu para abdome agudo cirúrgico. O anátomo patológico revelou Pbmicose no epiplon e ovário direito. A biópsia do endométrio mostrou endometrite crônica granulomatosa. A radiologia e a planigrafia revelaram nódulo parahilar direito. Os achados clínicos e laboratoriais permitiram explicar a provável origem do envolvimento genital.

Paracoccidioidomycosis is a systemic disease that predominantly affects males. Experimental models suggest that males are more susceptible to the disseminated form of the disease. In vitro studies have documented growth inhibition in the presence of estradiol and progesterone whereas testosterone does not. Paracoccidioidomycosis has been "well described involving the male genitalia. Female genital involvement is rare; perhaps related to hormonal inhibition of fungal growth. A 57 year-old causasian female is described who presented with a ten year history of diffuse abdominal pain with alternating diarrhea and. constipation. She went on to present with an acute surgical abdomen and proceeded to laparotomy. Histopathological study revealed involvement of the omentum, fallopian tubes and right ovary with Paracoccidioidomycosis. Endometrial biopsy revealed chronic granulomatous endometritis, however, no fungus was visualized. Chest X ray and tomography were consistent with right parahilar involvement. We suggest, pathophysiologically, that the genital disease represents reactivation of an abdominal focus.