Paracoccidioidomycosis of the testis

Paracoccidioidomycosis (PCM) is a fungal disease endemic to Latin America. PCM rarely involves the male genital tract and generally occurs in the disseminated form of the disease, in which other manifestations coexist. It can affect the penis, epididymis, testicle, and prostate^1,2,3.

A 53 year-old-man from a rural area presented with rapid and progressive growth of the left testicle, associated with local pain (Figure 1). In 2021, he was diagnosed with PCM and used itraconazole irregularly.

FIGURE 1:
Physical examination.

Initially,ultrasonography confirmed the diagnosis, without improvement after antibiotic therapy. The tumor markers were negative. Therefore, orchiectomy was performed.

Intraoperatively, the testis was soft and reduced in size. After opening the albuginea, a stroma with a necrotic appearance and purulent secretion and an enlarged and hardened epididymis were observed, with the presence of a large amount purulent secretion.

Anatomopathological examination revealed signs of PCM in the testes and epididymis (Figure 2A, B).

FIGURE 2A:
P. brasiliensis esporulation (40x, Grocott-Gomori).

FIGURE 2B:
Epithelioid macrophages, Langhans giant cells, and spores of P. brasiliensis within a granuloma (40x, Hematoxylin-eosin).

PCM of the male genital tract is rare, and according to recent studies, it appears to be the least affected site³.

The presentation is similar to that of a painful lesion, and the differential diagnosis includes squamous cell carcinoma, testicular tumors, leishmaniasis, syphilis, tuberculosis, orchiepidymitis. Diagnosis is made via biopsy, and direct microscopy with potassium hydroxide preparations rapidly identified the fungus. The first-line treatment was itraconazole at a dose of 200 mg/day for 9-18 months⁴.

ACKNOWLEDGMENTS

None.

REFERENCES

• ¹ Souza CÁ, Silva ACB, Ide M, Azevedo RL, Velho PENF, França AFEDC. Genital cutaneous ulcer as a manifestation of systemic mycosis: A rare presentation. Med Mycol Case Rep. 2023;42:100605. Available from: https://doi.org/10.1016/j.mmcr.2023.100605. PMID: 37693215; PMCID: PMC10482884.
  » https://doi.org/10.1016/j.mmcr.2023.100605
• ² Peçanha PM, Batista Ferreira ME, Massaroni Peçanha MA, Schmidt EB, Lamas de Araújo M, Zanotti RL, et al. Paracoccidioidomycosis: Epidemiological and Clinical Aspects in 546 Cases Studied in the State of Espírito Santo, Brazil. Am J Trop Med Hyg. 2017;97(3):836-44. Available from: https://doi.org/10.4269/ajtmh.16-0790. PMID: 28749757; PMCID: PMC5590575.
  » https://doi.org/10.4269/ajtmh.16-0790
• ³ Severo LC, Kauer CL, Oliveira F. de M, Rigatti RA, Hartmann AA, Londero AT. Paracoccidioidomycosis of the male genital tract. Report of eleven cases and a review of Brazilian literature. Rev Inst Med Trop Sao Paulo. 2000;42(1): 37-40. Available from: https://doi.org/10.1590/S0036-46652000000100006. PMID: 10742725
  » https://doi.org/10.1590/S0036-46652000000100006
• ⁴ Falcão EMM, de Macedo PM, Freitas DFS, Coutinho ZF, Quintella LP, Almeida-Paes R, et al. Destructive genital and oral ulcers in rural patients. JAAD Case Rep. 2021;11:127-9. Available from: https://doi.org/10.1016/j.jdcr.2021.03.036. PMID: 33997212; PMCID: PMC8094395.
  » https://doi.org/10.1016/j.jdcr.2021.03.036

• Financial Support:
  None.

Edited by

• Editor-in-Chief:
  Prof. Dalmo Correia Filho. Orcid: https://orcid.org/0000-0002-2174-5058

Publication Dates

• Publication in this collection
  27 Jan 2025
• Date of issue
  2025

History

• Received
  24 July 2024
• Accepted
  06 Sept 2024