Synchronous Mucocutaneous Paracoccidioidomycosis and Oral Squamous Cell Carcinoma: Report of Two Rare Cases

Paracoccidioidomycosis (PCM) is a neglected systemic mycosis in Latin America that frequently involves the oral cavity. We herein describe two rare cases of synchronous mucocutaneous PCM and oral squamous cell carcinoma (OSCC) in 42- and 48-year-old men from an endemic area of Southeast Brazil. Clinically, both patients presented with painful, ulcerated oral lesions exhibiting granular/moriform features and multifocal involvement. PCM was confirmed by histopathological examination demonstrating pseudoepitheliomatous hyperplasia and granulomatous inflammation with fungal yeast forms, supported by Grocott-Gomori methenamine silver staining. Fungal culture yielded cerebriform colonies with multiple budding yeasts. Chest radiography demonstrated PCM-related pulmonary involvement in both patients, and one also exhibited cutaneous disease. Itraconazole was prescribed for both patients; however, treatment was discontinued in one case due to resumption of alcohol consumption and in the other due to homelessness. In both cases, OSCC involved the floor of the mouth; one patient underwent surgical resection, whereas the other is currently receiving chemoradiotherapy. Given that OSCC may coexist with oral PCM, clinicians should maintain a high index of suspicion when evaluating granulomatous/moriform oral lesions and perform timely, multi-site biopsies, particularly in endemic areas.