Disseminated mycosis (DM)—with cardiac involvement and shock—is an unexpected and severe opportunistic infection in patients with yellow fever. DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing. We report the case of a 53-year-old male patient who presented to the emergency department with fever, myalgia, headache, and low back pain. The laboratory investigation revealed a positive molecular test for yellow fever, hepatic injury, and renal failure. During hospitalization, the patient developed hepatic encephalopathy, ascending leukocytosis, and ascites, with signs consistent with peritonitis. On the 11th day of hospitalization, the patient developed atrioventricular block, shock and died. At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.
QuaresmaJA, PagliariC, MedeirosDB, DuarteMI, VasconcelosPF. Immunity and immune response, pathology and pathologic changes: progress and challenges in the immunopathology of yellow fever. Rev Med Virol. 2013;23(5):305-18. [https://doi.org/10.1002/rmv.1752]. [PMID:23873723]
ter MeulenJ, SakhoM, KoulemouK, et al. Activation of the cytokine network and unfavorable outcome in patients with yellow fever. J Infect Dis. 2004;190(10):1821-7. [https://doi.org/10.1086/425016]. [PMID:15499539]
BestSM, MorrisKL, ShannonJG, et al. Inhibition of interferon-stimulated JAK-STAT signaling by a tick-borne flavivirus and identification of NS5 as an interferon antagonist. J Virol. 2005;79(20):12828-39. [https://doi.org/10.1128/JVI.79.20.12828-12839.2005]. [PMID:16188985]
Laurent-RolleM, MorrisonJ, RajsbaumR, et al. The interferon signaling antagonist function of yellow fever virus NS5 protein is activated by type I interferon. Cell Host Microbe. 2014;16(3):314-27. [https://doi.org/10.1016/j.chom.2014.07.015]. [PMID:25211074]
RodenMM, ZaoutisTE, BuchananWL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Nephrol Dial Transplant. 2005;41(5):634-53. [PMID:16080086]
HsiehTT, TsengHK, SunPL, WuYH, ChenGS. Disseminated zygomycosis caused by Cunninghamella bertholletiae in patient with hematological malignancy and review of published case reports. Mycopathologia. 2013;175(1-2):99-106. [https://doi.org/10.1007/s11046-012-9595-y]. [PMID:23124364]
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