Mauriac Syndrome in a 3-Year-Old Boy

ObjectiveTo report a case of Mauriac syndrome in a young child with poorly controlled type 1 diabetes mellitus.MethodsWe describe the typical features of Mauriac syndrome and review the clinical, laboratory, and ultrasound findings and follow-up results in our current patient.ResultsHepatomegaly, growth impairment, and cushingoid features characterize Mauriac syndrome. Most frequently, it is seen in adolescents and young adults with a history of poor glycemic control. In our current patient, a 3-year-old boy with type 1 diabetes mellitus of 2 years’ duration, Mauriac syndrome developed in the context of a disrupted social environment. His liver enzyme derangement, hepatomegaly, and growth improved once euglycemia was achieved.ConclusionAlthough Mauriac syndrome is currently uncommon, close monitoring of children with type 1 diabetes is important to maintain optimal glycemic control and prevent such an occurrence. (Endocr Pract. 2007;13: 63-66)     

Paracoccidioidomycosis in a four-year-old boy

A paracoccidioidomycosis case in a four-year old boy, with fever, lymphadenopathy and hepatosplenomegaly is presented. The diagnosis was confirmed by serology and lymph node biopsy. The patient was treated with amphotericin B. After 48 hours, clinical improvement and considerable adenopathies remission were observed.     

Paracoccidioidomycosis in a four-year-old boy

Summary A case of fatal, generalized paracoccidioidomycosis is described in a four-year-old urban dwelling child. Marked lympadenopathy, hepatosplenomegaly and an abdominal mass were the main clinical manifestations. The diagnosis was established by histopathological studies and culture. The authors comment on the rarity of this infection in children less than 7 years of age and on the importance of considering this pathology in the differential diagnosis of malignant non-Hodgkin lymphoma and tuberculosis, in children.Medical Student of the Federal University of Bahia.     

Sexual Precocity in A 2-Year-Old Boy Caused by Indirect Exposure to Testosterone Cream

ObjectiveTo report a rare case of sexual precocity caused by inadvertent exposure to testosterone cream.MethodsWe report the clinical, laboratory, and radiologic findings of a boy presenting with sexual precocity; review short- and long-term consequences; and discuss preventative measures.ResultsA₂ and 7/12-year-old boy had onset of pubic hair without testicular enlargement and a period of rapid linear growth. History revealed possible topical testosterone exposure from close contact with the child’s father. On physical examination, the boy had Tanner stage II pubic hair distribution. Laboratory evaluation findings were normal for age except for the testosterone concentration, which was comparable to late-pubertal and adult male levels at 371 ng/dL (reference range, < 3-10 ng/dL for prepubertal male). Brain magnetic resonance imaging and testicular ultrasonography were normal. Skeletal age was advanced at age 4 and 6/12 years. Repeated laboratory evaluation, after the child’s father ceased testosterone use, revealed a normal testosterone concentration of 10 ng/dL. Thus, this boy’s sexual precocity was attributed to inadvertent exogenous androgen exposure.ConclusionsWhen examining a child with sexual precocity, asking about possible exposure to androgens and estrogens is important. Patients being treated with these products should be educated about the possible risks of testosterone exposure to others and ways to limit exposure. (Endocr Pract. 2008;14:1027-1030)     

Paracoccidioidomycosis in women

A retrospective review of paracoccidioidomycosis cases seen between January 1966 to January 1997 revealled 27 of the 627 cases occurred in women (male to female ratio 27.3:1). Data for 23 of these 27 cases demonstrated the protective effect of female hormones.     

Paracoccidioidomycosis in a Woman with Idiopathic Hirsutism

Paracoccidioidomycosis, especially the chronic pulmonary form of the disease, is not commonly described in females. Data from in vitro and vivo studies support the hypothesis that estrogens might influence the pathogenesis of paracoccidioidomycosis in humans by inhibition of transition of conidia or mycelia to yeast form of Paracoccidioides brasiliensis. The authors describe a chronic progressive pulmonary form of paracoccidioidomycosis in a woman with idiopathic hirsutism. In addition to estrogens, the present report suggests that other hormonal factors might play an important role in the pathogenesis of paracoccidioidomycosis, including the increased production of 5alpha-dehydrotestosterone frequently described in individuals with idiopathic hirsutism.     

Paracoccidioidomycosis in a patient with acquired immunodeficiency syndrome

The authors report a case of paracoccidioidomycosis and other opportunistic diseases in a patient with acquired immunodeficiency syndrome.     

Paracoccidioidomycosis in a Dog: Case Report of Generalized Lymphadenomegaly

Paracoccidioidomycosis (PCM) is a severe systemic mycosis, endemic in Latin America and highly prevalent in Brazil, where it ranks eighth as a mortality cause among infectious and parasitic diseases in humans. The disease in animals has been little explored. It is observed that armadillos can harbor the fungus at high frequencies, although the active disease has not been well documented in this wild mammal. Dogs are susceptible to experimental infection, and the naturally acquired PCM-disease was reported only recently in a dog from Brazil. The present work reports the second case of naturally acquired PCM in a 6-year-old female dog that presented emaciation, lymphadenomegaly, and hepatosplenomegaly. Biochemical and pulmonary radiographic evaluation did not reveal any abnormalities. PCM was diagnosed by clinical findings, culturing, immunohistochemistry, and histopathology of popliteal lymph node. The fungus was recovered from popliteal lymph node, and the molecular analysis showed respective sequencing similarities of 99 and 100% for 803 nucleotides of the Gp43 gene and 592 nucleotides from the ITS-5.8S region of Paracoccidioides brasiliensis. Immunohistochemistry revealed severe lymphadenitis and presented numerous yeasts, which reacted against the gp43 antibody. Histopathology revealed a severe granulomatous lymphadenitis associated with numerous single or multiple budding yeasts. After diagnosis, the dog was successfully treated with itraconazol for 2 years. Veterinarians should be aware of the importance of considering PCM for differential diagnosis, especially in dogs from PCM-endemic areas, whose monophagocytic system involvement is evident.     

Serological Survey of Paracoccidioidomycosis in Sheep

The objective of this study was to evaluate the prevalence of antibodies against Paracoccidioides brasiliensis in sheep from Guarapuava, Paraná State, Brazil. The seroepidemiological study was carried out in 262 sheep. The samples were analyzed by ELISA and immunodiffusion test using P. brasiliensis gp43 and exoantigen as antigens, respectively. Initially, two sheep were immunized with P. brasiliensis to evaluate whether contact with the fungal cells could induce a humoral immune response against gp43 and exoantigen from P. brasiliensis. Both animals produced antibodies against gp43 and exoantigen, the main antigens used for diagnosis and seroepidemiology of paracoccidioidomycosis. A reactivity of 37% was observed to the P. brasiliensis gp43 antigen by ELISA although no reactivity had been observed by the immunodiffusion test. Sheep under extensive grazing system showed higher frequency of positivity to P. brasiliensis (P ≤ 0.05) than those under intensive and semi-intensive systems. These data suggest that sheep may be a useful epidemiological marker of P. brasiliensis presence in the environment and reinforce that contact with soil is an important risk factor for infection.     

Characterization of the Phenotype of 14- to 15-Year-Old Altaian Adolescents

The specific morphofunctional and psychophysiological features of Altaian and Russian adolescents living under the conditions of Gornyi Altai were studied. The comparative assessment of the morphological and psychophysiological parameters of the bodies of the adolescents allowed their individual typological variability depending on their nationality to be revealed.     

Serological Survey of Paracoccidioidomycosis in Cats

The objective of the present study was to evaluate infection of cats by Paracoccidioides brasiliensis. Serum samples of 136 cats from rural (n = 86) and urban areas (n = 50) were analyzed by indirect ELISA and immunodiffusion test using P. brasiliensis gp43 and exoantigen as antigens, respectively, and an overall reactivity of 31.6 % was observed by ELISA although no reactivity was detected by immunodiffusion. The positivity observed in animals living in rural areas (48.8 %) with free access to soil was significantly higher (P < 0.0001) than among urban animals (2 %) with limited access to soil, although no significant difference was observed in relation to age or sex. The high rates of positivity observed in cats from rural areas suggest that not diagnosed cases of this mycosis may be occurring in cats living in endemic areas for human paracoccidioidomycosis. This is the first report showing serological evidence of P. brasiliensis infection in cats.