Evolution of Pulmonary Ct Findings in Patients With Paracoccidioidomycosis Under Antifungal Therapy

Paracoccidioidomycosis (PCM) is the main endemic mycosis in Latin America, caused by fungi of the genus Paracoccidioides. Despite antifungal treatment, many patients develop pulmonary sequelae that can significantly impair quality of life and lead to future complications such as recurrent pneumonia, hypoxemia, pulmonary hypertension, and death. The main objective of this study was to evaluate the evolution of CT abnormalities before and after antifungal treatment in patients with PCM. A cohort of 21 patients with chronic PCM and pulmonary involvement was evaluated. All patients underwent high-resolution chest computed tomography (HRCT). HRCT images were assessed by experienced radiologists and classified by severity. Dependent variables were compared using McNemar’s test. P-values <0.05 were considered significant. All patients were male, with a median age of 56 years [45–60]. All were smokers, with a median smoking burden of 45 pack-years [35–75]. In the pre-treatment period, the most frequently observed CT findings were bronchial wall thickening (81.0%), centrilobular nodules (76.2%), large nodules (71.4%), parenchymal bands (71.4%), interlobular septal thickening (61.9%), emphysema (61.9%), traction bronchiectasis (57.1%), tree-in-bud pattern (47.6%), and architectural distortion (47.6%). All patients were treated: 45% with trimethoprim-sulfamethoxazole, 35% with itraconazole, and the remaining 20% with both drugs at different times. After antifungal therapy, reductions were observed in bronchial wall thickening (81.0% to 19.0%; p < 0.01), centrilobular nodules (76.2% to 38.1%; p = 0.02), and tree-in-bud pattern (47.6% to 9.5%; p < 0.01). There was a trend toward increased interlobular septal thickening (61.9% to 90.5%; p = 0.07). Thirteen (61.9%) patients developed significant pulmonary parenchymal sequelae (moderate and severe lesions), characterized by traction bronchiectasis (100%), architectural distortion (76.9%), intralobular septal thickening (69.2%), areas of hyperlucency (61.5%), and bullae (61.5%). These findings demonstrate a high incidence of fibrotic and emphysematous lesions in patients with PCM after antifungal therapy.