Paracoccidioidomycosis manifested by sarcoidosis-like cutaneous lesions and caused by Paracoccidioides brasiliensis sensu stricto (S1a)

Abstract

Molecular studies have shown more than one species of the genus Paracoccidioides to be the causal agent of paracoccidioidomycosis. Efforts have been made to correlate the identified species with epidemiological and clinical data of patients, aiming to determine the real meaning and impact of new species. Bearing this objective in mind, the authors report a clinical case of paracoccidioidomycosis, from São Paulo state, Brazil, that manifested as uncommon sarcoid-like cutaneous lesions and was caused by Paracoccidioides brasiliensis sensu stricto (S1a). The patient was treated with itraconazole 200mg/day for 12 months, with complete clinical remission.

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 (PCM) is a systemic mycosis caused by the thermally dimorphic fungus, Paracoccidioides brasiliensis ( P. brasiliensis ) [1] , [2] . This condition is endemic in Brazil, diagnosed more frequently in São Paulo State [7] .…”

“…Transmission occurs through the inhalation route, which in turn, can result in lymphohematogenous dissemination with distant metastatic foci. The main organs affected are the lungs, skin, mucosa, lymph nodes, adrenals, and the nervous system [1] , [2] .…”

“…Regarding the cutaneous-mucous manifestations, the morphology of the lesion is variable and may range from erythematous papules and nodules to vegetating ulcers [1] . There is also a rarer form that is infiltrated or has a lichenoid appearance, with almost exclusively cutaneous involvement, called sarcoid or sarcoidosis-like [2] , [3] .…”