Disseminated paracoccidioidomycosis diagnosis based on oral lesions

Abstract

Paracoccidioidomycosis (PCM) is a deep mycosis with primary lung manifestations that may present cutaneous and oral lesions. Oral lesions mimic other infectious diseases or even squamous cell carcinoma, clinically and microscopically. Sometimes, the dentist is the first to detect the disease, because lung lesions are asymptomatic, or even misdiagnosed. An unusual case of PCM with 5 months of evolution presenting pulmonary, oral, and cutaneous lesions that was diagnosed by the dentist based on oral lesions is presented and discussed.

Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

“…According to gender and age we observed that PCM oral manifestations were more frequent in male patients, with 89.65% cases and age range of 41 to 62 years (75.85%), as it has been observed in earlier studies [5][6][7]. PCM oral manifestations occur at almost all ages, with highest incidence in ages between 30 and 50 years in its chronic form (adult type), which is the most common in 90% of the cases, with classic signs and symptoms that include pulmonary and mucosal involvement [5,6].…”

“…In PCM, alcoholic habit was important in 31.03% of the cases, as previously described in Brazil [2,7]; whilst in cases of histoplasmosis only 5.5% of them were associated to such factor, similar to the findings described in Venezuela [1,11]. Other important risk factors for histoplasmosis are those related to fungal exposure by previous contact with bird or bat droppings: 38.88% of the cases involved such risk factor.…”

“…Other important risk factors for histoplasmosis are those related to fungal exposure by previous contact with bird or bat droppings: 38.88% of the cases involved such risk factor. Similar data was described in Brazil [2,7] and Mexico [12] for PCM and in Venezuela for histoplasmosis [1,11].…”

“…Thus, dentists need to be aware of the clinical oral manifestations it causes in patients and take advantage of epidemiological clues that suggest risk factors for contracting these mycoses. Furthermore, dentists must be familiar with the use and limitations of the current diagnostic tests available for fungal diseases [1,7,8].…”

“…Therefore, it is important to establish a casuistry and account of these diseases as differential diagnoses in endemic areas such as Venezuela [5][6][7].…”