Extrahepatic cholestasis associated with paracoccidioidomycosis: Challenges in the differential diagnosis of biliopancreatic neoplasia

Table 1 Clinical manifestations of patients with paracoccidioidomycosis and extrahepatic cholestasis allocated to the clinical management (group 1) and clinical/endoscopic/surgical management (group 2) groups, n (%)

Symptom	Group 1 (n = 27)	Group 2 (n = 13)	P value
Abdominal pain	26 (96.2)	10 (76.9)	0.092
Lymphadenomegaly	25 (92.5)	9 (69.2)	0.074
Hepatomegaly	21 (77.7)	7 (53.8)	0.153
Skin lesions	21 (77.7)	12 (92.3)	0.393
Choluria	18 (66.6)	7 (53.8)	0.498
Splenomegaly	18 (66.6)	7 (53.8)	0.498
Fever	17 (62.9)	7 (53.8)	0.733
Vomiting	12 (44.4)	5 (38.5)	1.000
Weight loss (> 10 kg)	8 (29.6)	8 (61.5)	0.085
Ascites	7 (25.9)	3 (23.0)	1.000
Pruritus	6 (22.2)	8 (61.5)	0.031

Table 2 Mean level of total bilirubin, direct bilirubin, alkaline phosphatase, aspartate aminotransferase, and albumin before and after treatment of patients with paracoccidioidomycosis and extrahepatic cholestasis allocated to groups 1 and 2

Laboratory	Pre-group 1	Post-group 1	Pre-group 2	Post-group 2
TB (mg/dL)	5.10	1.90a	6.60	0.90a
DB (mg/dL)	3.20	0.40a	4.40	0.28a
AP (U/L)	1144.40	255.40a	1045.00	192.70a
AST (U/L)	94.10	55.90a	99.60	45.60a
Albumin (mg/dL)	2.80	4.10	3.10	3.50

^aP > 0.05.

TB: Total bilirubin; DB: Direct bilirubin; AP: Alkaline phosphatase; AST: Aspartate aminotransferase.

Table 3 Incidence of abnormal imaging findings in patients with paracoccidioidomycosis and extrahepatic cholestasis allocated to groups 1 and 2, n (%)

Imaging finding	Group 1	Group 2	P value
	n = 27	n = 13
Abdominal lymphadenomegaly	21 (77.7)	10 (76.9)	1.000
Hepatomegaly	20 (74.0)	7 (53.8)	0.283
Biliary dilatation	18 (66.6)	10 (76.9)	0.715
Splenomegaly	4 (14.8)	6 (46.1)	0.052
Pancreatic head mass	3 (11.0)	5 (38.0)	1.000