The Deep Mycoses (Essentially or Potentially Systemic) 213 



Smith, I M., ^nd W ute, VV. \\ Coccidioidal gramdoma: Reporl ol Fatal case, Southwest. 



Med. 18:304, 1934. 

 Tomlinson, C. (".. \\n Banchoft, I.: Granuloma coccidioides: Further observations on use 



oi antimony and potassium tartrate and roentgen rays in treatment: Report ol additional 



case, J. \ M. \ 102:36, L934. 

 /i isi mi. E. 1'.: Chronic coccidioidal dermatitis, Arch. Dermat. & Syph. 25:52, L932, 



8. GRANULOMA PARACOCCIDIOIDES 

 (ilc Almeida's Disease; Lutz's Disease) 



Both de Almeida and Weidman ha\ e called attention to tlie clinical and 

 etiologic differences between this disease and granuloma coccidioides. 

 There are also marked points of similarity, so that only thorough clinical 

 and mycologic study of the patient may reveal the diagnosis. Conant and 

 Howell's observations stressed a close relationship between this disease and 

 American blastomycosis. Their report was discussed by Moore. Weidman 

 and Hopkins, all of whom disagreed with their findings. 



(a) Etiology.— The infecting micro-organism is known as Paracoc- 

 cidioides brasiliensis. The disease is seen only in South America. De Almeida 

 collected 257 cases previously reported as instances of granuloma coc- 

 cidioides; in all but two the causal organism was probably P. brasiliensis. 

 According to de Almeida, young adult males are chiefly affected, particu- 

 larly manual workers in agricultural occupations. 



(b) Symptoms.— The clinical course is similar to that of granuloma coc- 

 cidioides except that the portal of entry is usually in or around the mouth. 

 The lesions are granulomatous and may or may not ulcerate; they are usu- 

 ally painful. Secondary lesions may appear in the gums, tongue and face, 

 particularly around the nose. Adenopathy severe enough to simulate that 

 of Hodgkin's disease may be found; in this respect the condition differs 

 from the North American disease. A lvmphangitic form is described, begin- 

 ning in lymph nodes. At times abdominal pain points to involvement of the 

 intestines, a site not known for granuloma coccidioides and blastomycosis. 

 The liver, spleen, lungs and other organs may also be invaded. 



(c) Differential diagnosis.— The geographic origin of the patient may 

 assist. The majority ( if not all ) of patients with infections due to P. brasili- 

 ensis are from South America. At times blastomycosis and granuloma coc- 

 cidioides may be differentiated only by mycologic study although the mu- 

 cocutaneous involvement is usually distinctive. 



(d) Prognosis.— The outlook is almost uniformly hopeless. The patients 

 succumb to the infection within a few weeks to a few months. 



(e) Treatment.— Therapy is similar to that noted for granuloma coc- 

 cidioides. The iodides are occasionallv helpful. 



