Paracoccidioidomycosis with mucocutaneous involvement. A case report

Abstract

Paracoccidioidomycosis is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis, with a high incidence in Brazil and Latin America. The disease is clinically, classified in a juvenile - acute form and a chronic adult form. The primary lesion starts in the lungs through the inhalation of Paracoccidioides brasiliensis through the respiratory tract. It may spread hematogenously and lymphatically to other organs, as well as the skin and mucous membranes. Skin and mucosa manifestations are characterized by the formation of granulomatous lesions, organized according to the type of host¨s pattern of immune response. People that works in agriculture and lives in rural areas are considered high risk of infection group. The diagnosis is based on direct identification of the fungus with the microscope, culture or histology sample of the clinical specimen. In addition, molecular biology techniques such as polymerase chain reaction (PCR) demonstrate high sensitivity, considered appropiate for diagnosis and follow-up treatment. The choice of treatment depends on the state of the disease and is medicated with azole derivatives such as amphotericin B and sulfonamides. It is reported the case of a male patient, a farmer, with no systemic contributor, who inhaled Paracoccidioides brasiliensis. He presented granulomatous lesions in oral cavity, clinical, imaging and histopathological examinations were carried out, to diagnose paracoccidioidomycosis with mucocutaneous affectation. He was successfully treated at the oral and maxillofacial surgery service of the National Hospital Hipólito Unanue (HNHU) Lima-Peru.