Clinical presentation of paracoccidioidomycosis (PCM) can be diverse. Morphology and quantity of skin lesions depends on interactions between host immunity and fungus virulence. Diagnosis can be a challenge considering that this fungus has low virulence and some individuals have immunity to microorganism, which results in well-marked granulomas without visible microorganisms. We report herein a clinical presentation of sarcoid-like PCM, initially diagnosed as tuberculoid leprosy. This rare type of PCM is often mistaken for other types of chronic granulomatous diseases. Diagnosis was confirmed after 4 years when a special stain analysis helped in the identification of the specific etiologic agent.
Histiocytoses are rare diseases caused by the proliferation of histiocytes. The
pathogenesis remains unknown and the highest incidence occurs in pediatric
patients. The clinical presentations can be varied, in multiple organs and
systems, and the skin lesions are not always present. Evolution is unpredictable
and treatment depends on the extent and severity of the disease. It is described
the case of a patient with various neurological symptoms, extensively
investigated, who had its was diagnosed with histiocytosis from a single skin
lesion. This report highlights the importance of Dermatology in assisting the
investigation of difficult cases in medical practice.
A patient with systemic involvement, initially treated as tuberculosis, is
presented in this report. There were only two painful subcutaneous nodules, from
which we arrived at the correct diagnosis of histoplasmosis. The patient was
attended by several experts in the fields of infectious diseases, nephrology and
internal medicine, but the diagnosis was only possible after dermatological
examination and skin biopsy. This case values multidisciplinary interaction
between dermatologists and other medical areas for diagnosis of cases with
atypical manifestations.
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