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Case report
First report of paracoccidioidomycosis reactivation as a complication of immunosuppressive therapy for acute severe colitis in a caving enthusiast
  1. Scott Healey,
  2. Waseem Said,
  3. Faisal Fayyaz and
  4. Andrew Bell
  1. Department of Gastroenterology, Weston Area Health NHS Trust, Weston-super-Mare, England, UK
  1. Correspondence to Dr Scott Healey; schealey{at}


Treatment for ulcerative colitis often requires the administration of immunosuppressive therapy. Shortly after rescue therapy with infliximab for acute severe colitis, a patient who was also taking corticosteroids, azathioprine and adalimumab became rapidly unwell with atypical pneumonia, which did not respond to conventional antimicrobials. Re-examining the travel history revealed a prior caving trip to Costa Rica. Dimorphic fungal serology was thus tested and a diagnosis of paracoccidioidomycosis was made. After a lengthy intensive care unit admission, the patient made a recovery after the administration of appropriate antifungal therapy and was discharged home on long-term oral antifungals.

  • ulcerative colitis
  • pneumonia (infectious disease)
  • travel medicine
  • tropical medicine (infectious disease)
  • inflammatory bowel disease

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  • Contributors The case was identified by AB. The abstract, case summary, discussion and learning points were written by SH and WS. SH conducted the literature search and did the referencing. AB and FF critically appraised/edited the case report. AB is responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.