Unusual Presentation of Paracoccidioidomycosis Cavitated Lung Masses and Mediastinal Involvement Diagnosed by Endobronchial Ultrasound

Paracoccidioidomycosis is a systemic mycosis endemic to Latin America. Pulmonary involvement in its chronic form is frequent, but involvement in the form of nodules and cavitated masses is rare, as is mediastinal involvement. A 61-year-old man presented with a 3-month history of involuntary weight loss of 20 kg, cough with purulent expectoration, dyspnea, fever, and night sweats. Chest computed tomography revealed multiple masses, nodules, and cavities, with bilateral mediastinal and perihilar adenopathy. Bronchoscopy and radial and linear endobronchial ultrasound-guided transbronchial needle aspiration were used. Pathological analysis reveals nonnecrotizing microgranulomas and round fungal structures compatible with paracoccidioidomycosis. We present this case as a rare presentation of paracoccidioidomycosis, to be considered as a differential diagnosis of lung nodules, with cavitation and mediastinal involvement.