{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,6,15]],"date-time":"2024-06-15T00:20:53Z","timestamp":1718410853122},"reference-count":16,"publisher":"Baishideng Publishing Group Inc.","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Gastrointest Oncol"],"abstract":"BACKGROUND<\/jats:p>\n Paracoccidioidomycosis (PCM) may involve the hepatic pedicle and peripancreatic lymph nodes, cause damage to the bile duct and manifest, exceptionally, in combination with extrahepatic cholestasis (EHC), making investigation and treatment challenging.<\/jats:p>\n AIM<\/jats:p>\n To investigate the management of patients with visceral PCM admitted with EHC.<\/jats:p>\n METHODS<\/jats:p>\n All patients diagnosed with PCM treated in a public, tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated. Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical, laboratory, and imaging findings, resources used for etiological diagnosis, treatment results, and prognosis. Statistical analyses were performed using the linear mixed-effects model (random and fixed effects), which was adjusted using the PROC MIXED procedure of the SAS\u00ae 9.0 software, and Fisher\u2019s exact test.<\/jats:p>\n RESULTS<\/jats:p>\n Of 1645 patients diagnosed with PCM, 40 (2.4%) had EHC. Of these, 20 (50.0%) lived in the rural area and 29 (72.5%) were men, with a mean age of 27.1 years (3-65 years). Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients (40.0%), and a mass in the head of the pancreas was observed in 8 (20.0%). The etiological diagnosis was made by tissue collection during surgery in 4 cases (10.0%) and by endoscopic methods in 3 cases (7.5%). Twenty-seven patients (67.5%) received drug treatment alone (Group 1), whereas 13 (32.5%) underwent endoscopic and\/or surgical procedures in combination with drug treatment (Group 2). EHC was significantly reduced in both groups (40.7% in Group 1, with a mean time of 3 months; and 38.4% in Group 2, with a mean time of 7.5 months), with no statistically significant difference between them. EHC recurrence rates, associated mainly with treatment nonadherence, were similar in both groups: 37% in Group 1 and 15.4% in Group 2. The mortality rate was 18.5% in Group 1 and 23% in Group 2, with survival estimates of 71.3% and 72.5%, respectively, with no statistically significant difference.<\/jats:p>\n CONCLUSION<\/jats:p>\n Although PCM-related EHC is rare, it needs to be included in the differential diagnosis of malignancies, as timely treatment can prevent hepatic and extrahepatic sequelae.<\/jats:p>","DOI":"10.4251\/wjgo.v16.i6.2531","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T07:43:34Z","timestamp":1718351014000},"page":"2531-2540","source":"Crossref","is-referenced-by-count":0,"title":["Extrahepatic cholestasis associated with paracoccidioidomycosis: Challenges in the differential diagnosis of biliopancreatic neoplasia"],"prefix":"10.4251","volume":"16","author":[{"given":"Jos\u00e9 Sebasti\u00e3o","family":"dos Santos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vitor","family":"de Moura Arrais","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William Jos\u00e9","family":"Rosseto Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Ribeiro Correa Filho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari\u00e2ngela Ottoboni","family":"Brunaldi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Kemp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajith Kumar","family":"Sankanrakutty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Elias Junior","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Bellissimo-Rodrigues","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edson","family":"Zangiacomi Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Celso","family":"Ardengh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2060","published-online":{"date-parts":[[2024,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/jof8101098"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00233-21"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2303.2009.00644.x"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1439-0507.2003.00881.x"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-005-2670-x"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1080\/02681219580000141"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1590\/s0037-86821987000200012"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.mmcr.2018.01.005"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7869\/tg.244"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1978.tb01716.x"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i34.5750"},{"key":"B12","unstructured":"Chaib E, de Oliveira CM, Prado PS, Santana LL, Toloi J\u00fanior N, de Mello JB. Obstructive jaundice caused by blastomycosis of the lymph nodes around the common bile duct. Arq Gastroenterol 1988; 25: 198-202"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-007-9047-2"},{"key":"B14","unstructured":"Blanchard R, Schwartz E, Binot J. Sur une blastomycose intra-periton\u00e9ale. Arch Parasitol 1903; 7: 489"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjid.2021.101605"},{"key":"B16","unstructured":"Fiorillo M, Martinez R, Moraes C. Blastomicose sul americana. In: Del Negro G, Lacaz CS, Fiorillo M. Paracoccidioidomycose. S\u00e3o Paulo: Sarvier, 1982: 179-193"}],"container-title":["World Journal of Gastrointestinal Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.wjgnet.com\/1948-5204\/full\/v16\/i6\/2531.htm","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.wjgnet.com\/1948-5204\/full\/v16\/i6\/2531.htm","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T07:45:33Z","timestamp":1718351133000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.wjgnet.com\/1948-5204\/full\/v16\/i6\/2531.htm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,15]]},"references-count":16,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4251\/wjgo.v16.i6.2531","relation":{},"ISSN":["1948-5204"],"issn-type":[{"value":"1948-5204","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6,15]]}}}