{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:05:26Z","timestamp":1785423926681,"version":"3.56.0"},"reference-count":24,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["ASM Case Rep"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:sec>\n                      <jats:title>Background<\/jats:title>\n                      <jats:p>Paracoccidioidomycosis is a systemic mycosis endemic to Central and South America. Here, we describe an unusual case of an elderly female with cutaneous paracoccidioidomycosis and comorbidities limiting the use of first-line therapeutic agents.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                      <jats:title>Case Summary<\/jats:title>\n                      <jats:p>\n                        An 89-year-old female with a past medical history of advanced systolic heart failure presented with decompensated heart failure along with chronic, progressive ulcerating lesions involving multiple fingers, unresponsive to antibiotic therapy. A biopsy showed evidence of yeast on pathology and samples grew\n                        <jats:italic toggle=\"yes\">Paracoccidioides brasiliensis<\/jats:italic>\n                        within 5 days on routine bacterial culture. Further history revealed that she lived in Trinidad and Tobago for periods during her childhood and had visited Ecuador for 2 weeks decades prior. Due to her history of advanced congestive heart failure on dobutamine and ventricular arrhythmias, first-line therapy with itraconazole was contraindicated. Sulfamethoxazole-trimethoprim was initiated; however, she developed progressive renal dysfunction and hyperkalemia attributed to sulfamethoxazole-trimethoprim, necessitating a change in therapy. The patient was ultimately started on isavuconazole, which has been shown to be effective in the treatment of\n                        <jats:italic toggle=\"yes\">Paracoccidioides<\/jats:italic>\n                        in a small phase 3 trial. Unfortunately, we were unable to observe clinical response to isavuconazole in our patient due to her demise in the setting of advanced heart disease.\n                      <\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                      <jats:title>Conclusion<\/jats:title>\n                      <jats:p>This case highlights the variable nature of paracoccidioidomycosis, with our patient having a prolonged latency prior to development of clinical signs and symptoms, an unusual diagnosis by growth in routine bacterial culture, and the need for further research in alternative therapeutic options.<\/jats:p>\n                    <\/jats:sec>\n                  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