Disseminated paracoccidioidomycosis with a pulmonary-spine fistula: suggestive of contiguous spread

Paracoccidioidomycosis (PCM) rarely involves the spine. We report a 55-year-old man with disseminated PCM presenting with thoracic spinal cord compression and an unprecedented pulmonary-spine fistula identified intraoperatively. Diagnosis was confirmed by histopathology and mycology. The patient underwent surgical decompression and stabilization followed by itraconazole, achieving complete neurological recovery. This case highlights a unique complication of PCM and supports combined surgical and antifungal management in cases with neurological compromise.