Paracoccidioidomycosis (PCM) is endemic in Southeastern, Southern, and Central-Western Brazil. In the Northeast, the disease is less frequent. In Ceará, few autochthonous cases have been described in the literature: two in Palmácia (Serra de Baturité) and one in Camará (Serra de Uruburetama). However, in Serra de Pereiro, the prevalence of PCM based on intradermal testing with paracoccidioidin reached 32.1%. These areas share characteristics that favor the presence of the fungus, such as humid tropical climate, higher altitude, high rainfall, and predominance of agriculture—especially banana cultivation. We report an autochthonous case of PCM in a patient from Serra de Pacoti. A 38-year-old male farmer had had altered bowel habits since 2020 (alternating diarrhea and constipation) and significant, unquantified weight loss. In November 2023, he was hospitalized with a wasting syndrome, severe abdominal pain, and signs of peritoneal irritation. Abdominal CT showed irregular parietal thickening in the colon and retroperitoneal lymphadenopathy (up to 5.4 cm), suggesting inflammatory bowel disease or neoplasia. Colonoscopy showed fibrinous ulcers and stenosis in the transverse colon. He underwent laparotomy with right ileocolectomy in December 2023. Pathology demonstrated fungal structures compatible with Paracoccidioides spp. in the terminal ileum, right colon, appendix, omentum, and pericolic lymph nodes. Serology and cervical lymph node biopsy were also positive. He was treated with lipid complex amphotericin B for two weeks, followed by itraconazole 400 mg/day. He was discharged after three months of hospitalization. He has progressed well clinically and remains in outpatient follow-up with a colostomy. This is an autochthonous PCM case in a municipality of Ceará, outside the traditionally endemic axis. Although Ceará is predominantly arid, there are humid mountainous areas with environmental conditions favorable to the fungus, suggesting micro-territories with Paracoccidioides spp. circulation. The atypical presentation in a non-endemic area reinforces the importance of broadening diagnostic consideration in patients with chronic gastrointestinal syndromes in mountainous areas of Northeastern Brazil. Epidemiological and molecular studies are needed to better understand the territorial expansion of PCM in Ceará.
Almeida et al. (2026) studied this question.