Cecal appendicitis as a rare manifestation of paracoccidioidomycosis: a case report and systematic review of the literature

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America, with the acute/subacute form predominantly affecting children and young adults. Cases of cecal appendicitis caused by Paracoccidioides spp. have rarely been reported. This study aimed to describe the clinical manifestations and evolution of a case of cecal appendicitis due to PCM and to conduct a systematic literature review. A case report and systematic review were conducted using Embase, Web of Science, LILACS, MEDLINE, LIEPCS, PubMed, SciELO, and Gray Literature databases. We present the case of a 20-year-old male with generalized lymphadenopathy who was diagnosed with PCM and treated with oral trimethoprim-sulfamethoxazole. After the initial improvement, the patient returned with clinical deterioration. The treatment was changed to liposomal amphotericin B. Six days later, the patient developed an acute abdomen and underwent exploratory laparotomy with appendectomy. Histopathological examination confirmed acute granulomatous appendicitis due to PCM, and the patient showed postoperative clinical improvement. Of the 11 identified articles included in the systematic review, most case reports with a low risk of bias were found in South American countries. Five patients had confirmed appendicitis due to PCM through biopsy, while others had confirmed PCM at another site. Two patients were initially misdiagnosed with Crohn's. Most studies have reported favorable outcomes. Appendicitis caused by PCM is rare, even in endemic countries. It has a benign course when properly treated with both clinical and surgical management. This should be considered in the differential diagnosis of acute abdomen with lymphadenopathy in endemic regions.