Chronic pulmonary paracoccidioidomycosis masquerading as lymphangitis carcinomatosa.

for an intraduct carcinoma of the breast; this was grade TI NOMO, although at subsequent follow up she had not developed clinical metastatic disease. She had smoked cigarettes (total 60 pack years). She had worked as a clerk in Buenos Aires (1961-4) and Caracas (1965-7) but had not revisited South America in the last 17 years. There were no abnormalities on examination. Investigations showed: haemoglobin 15.7 g/dl; white cell count 8.3 x 109/l (differential count neutrophils 65%, eosinophils 4%, lymphocytes 28%, monocytes 3%); erythrocyte sedimentation rate 17 mm in one hour; blood urea and electrolyte concentrations normal; liver function normal; serum calcium normal; aspergillus and avian precipitins negative; serum angiotensin converting enzyme activity 83 (reference range 16-52) nmol ml1 min'1. A chest radiograph showed diffuse bronchocentric interstitial shadowing in both mid and lower zones (fig 1). Retro-