An unusual case of paracoccidioidomycosis in Brazil

Abstract

This paper reports an unusual case of paracoccidioidomycosis with ulcerations in the head and nose in a Brazilian man. For diagnosis, direct microscopic examination of ulcer secretion and skin samples treated with potassium hydroxide was performed. The isolation of Paracoccidioides brasiliensis occurred at 28ºC and 37ºC on Sabouraud agar with chloranphenicol. Diagnosis was established by the presence of isolated and multiple budding yeast-like cells and typical fungus growth of P. brasiliensis. Key words: Paracoccidioidomycosis, Paracoccidioides brasiliensis, unusual head lesionParacoccidioidomycosis is one of the most important systemic mycosis affecting residents of tropical and subtropical regions in Latin America (3,5). The etiological agent is the dimorphic fungus Paracoccidioides brasiliensis, which occurs in the filamentous form in nature, and the disease is thought to be acquired by inhalation of the propagules produced by this phase. The most common way of penetration in human body is through the lungs, with later lymph-hematogenic dissemination to other organs, skin or mucosas: buccal, pharyngeal, intestinal and rarely by inoculation into the skin (2). Clinical manifestations range from asymptomatic pulmonary lesions to generalized systemic infections (1,7,8,11).We present an unusual case of paracoccidioidomycosis diagnosed in Brazil. In June 2005, a 47-year-old Brazilian man arrived in the Sector of Pneumology at Otávio Freitas hospital in Recife state of Pernambuco, in Northeast of Brazil, with a suspect of tuberculosis and history of swellings and ulcerations of his nose and head (Fig. 1). Several months before, he had presented chronic bronchitis with fever episodes. A chest X ray revealed bilateral, diffuse pulmonary infiltrates. Skin lesions were painful and the patient was physically and psychologically handicapped, and clinical symptoms included occasional night sweats. No acid-fast bacilli or malignant cells were detected during exams.