Sarcoid-like cutaneous lesions in chronic adult paracoccidioidomycosis: report of two cases

Abstract

This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

Paracoccidioidomycosis with sarcoid-like cutaneous lesion: A clinicopathological challenge

“…There is a variant of cutaneous PCM that manifests itself in the skin with infiltration, similar to sarcoidosis, called sarcoid or sarcoidosis-like form, being considered a subtype of PCM-disease [1] , [3] . This form is rare and histologically characterized by the presence of tuberculoid granulomas and scarcity of fungal structures [1] , [2] , [3] , [4] , [5] , [8] . This is due to the host's immune response, because when the individual presents a competent immune response to P. brasiliensis , a stimulus is given to generate the T helper 1 (Th1) lymphocytes response.…”

Paracoccidioidomycosis in a child: exuberant presentation due to the inadvertent use of systemic corticosteroids

“…quently, this manifestation is reported as being caused by misdiagnosis, justifying the initial diagnosis of sarcoidosis in this case. [4][5][6] The sarcoid pattern of PCM can be determined by a specific immune response, which leads to a certain balance between agent and host and generates paucifungal histological exams, hindering the correct diagnosis. 7 In this case, treatment with prednisone probably altered such balance, favoring an immunosuppression that allowed lesions to evolve into ulcerated forms, which are more typical of the disease and contain an increased amount of yeasts, facilitating the correct diagnosis.…”