FDG-PET/CT Demonstrates Superior Detection of Multiorgan Involvement in Paracoccidioidomycosis Compared with Conventional Staging

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ID: 318053
2026
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Ranked #434 of 635 articles by views in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Abstract
BACKGROUND: Paracoccidioidomycosis (PCM) is a neglected systemic mycosis in which accurate staging is critical but challenging with conventional methods. This study evaluated 18F-FDG PET/CT compared with standard evaluation for PCM staging and assessed its impact on disease severity classification. METHODS: Thirty-four patients with confirmed PCM (treatment-naïve or with suspected treatment failure) underwent conventional staging and whole-body 18F-FDG PET/CT. Disease severity was classified as mild, moderate, or severe. PET/CT images were analyzed qualitatively and quantitatively (SUVmax, TMLV, TLG). RESULTS: PET/CT detected more than twice as many lesions as conventional evaluation (150 vs. 62; mean 4.4 ± 1.6 vs. 1.8 ± 0.9 affected organ systems per patient), with statistically significant superiority for lymph node, pulmonary, and adrenal involvement (McNemar's test, p < 0.05). PET/CT reclassified 97% of patients as multifocal versus 59% by conventional staging, and produced a significant unidirectional shift toward higher severity-the proportion classified as severe increased from 70.6% to 91.2% (p = 0.016). Patients with suspected treatment failure showed significantly lower TMLV and TLG than treatment-naïve patients (p < 0.05). Quantitative PET parameters correlated with serological titers and inflammatory markers (p < 0.05), and PET/CT detected four times as many sites as gallium-67 scintigraphy. CONCLUSION: 18F-FDG PET/CT systematically reveals greater disease burden than conventional evaluation in PCM, reclassifying most patients toward higher severity with direct implications for treatment duration and follow-up. Where available, it should be considered an important complementary modality for initial disease assessment.
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Authors Pricila Gama da Cunha, Maria Emília Seren Takahashi, R.s.b. Stucchi, Mariana Paixão Ribeiro, Thiago Ferreira de Souza, Cármino Antônio De Souza, Barbara Juarez Amorim, Maria Luíza Moretti, Plı́nio Trabasso, Celso Darío Ramos
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Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2026
DOI
10.1093/cid/ciag372
URL
https://doi.org/10.1093/cid/ciag372
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