Disseminated juvenile paracoccidioidomycosis: a case report and literature review

We report a case of juvenile paracoccidioidomycosis in a previously healthy patient and aim to raise awareness of its severe and atypical clinical manifestations. A 16-year-old male student, employed in automotive cleaning services, originally from Pará and residing in Embu das Artes, São Paulo, presented with progressive lymphadenopathy, jaundice, and signs of acute liver failure. He was admitted to a tertiary hospital, where imaging and histopathological analyses confirmed the diagnosis of paracoccidioidomycosis by identifying Paracoccidioides spp. on lymph node biopsy using periodic acid-Schiff and Grocott's methenamine silver stains. The patient subsequently developed hepatic dysfunction, ascites, encephalopathy, and acute kidney injury. He progressed to sepsis due to Acinetobacter baumannii infection and required intensive care support, including broad-spectrum antimicrobial treatment, antifungal therapy, vasopressor support, and renal replacement therapy. Despite aggressive management, the patient died from septic shock and multiorgan failure. Histopathological examination confirmed disseminated fungal infection. This case highlights a rare and severe hepatic presentation of juvenile paracoccidioidomycosis and reinforces the importance of including systemic mycoses in the differential diagnosis of acute febrile illnesses accompanied by hepatosplenomegaly and lymphadenopathy in endemic regions.