Oral paracoccidioidomycosis: a case without lung manifestations

Area of Science:

• Mycology
• Infectious Diseases
• Oral Medicine

Background:

• Paracoccidioidomycosis (PMC) is a significant endemic fungal infection in Latin America, caused by Paracoccidioides brasiliensis.
• Typically affecting adult males, PMC is acquired via inhalation and can disseminate from the lungs to other sites, notably the oral cavity.
• Antifungal therapy is curative for PMC.

Observation:

• A 58-year-old male presented with a two-year history of painless, ulcerated oral lesions on the floor of the mouth, alveolar ridge, and hard palate.
• Clinical examination revealed facial asymmetry due to lip edema and lymphadenopathy, with no respiratory symptoms or pulmonary radiographic findings.
• Histopathological examination of oral biopsies confirmed the presence of Paracoccidioides brasiliensis via special staining, while pulmonary biopsies were normal.

Findings:

• The differential diagnosis included squamous cell carcinoma and paracoccidioidomycosis based on clinical, radiographic, and histological data.
• A definitive diagnosis of paracoccidioidomycosis was established after comprehensive oral and pulmonary evaluations.
• Treatment with ketoconazole resulted in complete resolution of oral lesions within two months.

Implications:

• This case underscores the importance of considering oral manifestations of systemic diseases, particularly paracoccidioidomycosis.
• Dentists play a critical role as the initial point of contact for patients with oral lesions suggestive of systemic infections.
• Prompt diagnosis and management are essential for successful treatment outcomes in cases of atypical paracoccidioidomycosis presentation.