A fatal case of human pulmonary adiaspiromycosis

Abstract

A fatal case of human pulmonary adiaspiromycosis is reported. The patient, a male farm laborer from Pernambuco, in the Northeastern part of Brazil, had moved to Planaltina, DF., one year prior the onset of his illness. The main clinical manifestations consisted in fever, myalgia, cough and dyspnea. After being sick for five weeks, the patient developed severe respiratory failure and died. Grossly, disseminated nodular lesions, a few millimeters in diameter, were observed throughout the lobes of both lungs. Microscopically, round structures, up to 600 microns in diameter, with a thick membrane, identified as adiaconidia of Chrysosporium parvum var. crescens, were seen in the center of the nodular lesions. These adiaconidia appeared predominantly inside microabscesses or necrotic areas, both surrounded by a granulomatous reaction. The pulmonary alveoli not affected by the nodular lesions contained an inflammatory exudate composed of macrophages and neutrophils. The finding of several non-fatal cases of the disease in the area of the Federal District suggests that adiaspiromycosis is endemic in the Central Brazilian Plateau region, where the dry, warm and windy climate, particularly from August to October, may provide the appropriate environmental conditions for the dissemination of C. parvum conidia.