Paracoccidioidomicose sistêmica multifocal: desafio diagnóstico por manifestação cutânea tardia

Abstract

No Brasil, a paracoccidioidomicose é uma micose sistêmica endêmica frequente na zona rural e em homens adultos. É relatado caso em agricultor, usuário de drogas ilícitas, com manifestações insidiosas, atingindo rins, pulmões, gânglios, ossos e tardiamente pele, com atraso no diagnóstico e na terapêutica eficaz em mais de um ano. É importante incluir a paracoccidioidomicose como diagnóstico diferencial frente a um quadro sugestivo, mesmo na ausência de lesões cutâneas, para reconhecimento e tratamento precoce, em vista da elevada morbimortalidade desta entidade.

Disseminated paracoccidioidomycosis diagnosis based on oral lesions

“…These could be fungal, bacterial, or viral. [5] Among infectious diseases, PCM and tuberculosis are those that usually present lung and oral manifestations concurrently. [67] The most common oral manifestations of these diseases are ulcerative lesions, especially in the palate and gums.…”

“…[3] The diverse clinical presentation regarding frequency, number, distribution, and morphology of the skin lesions is related to the interaction between agent and host. [5] About 60% of cases, presents concomitantly in oral mucosa and skin. However, skin lesions often occur in head and neck region.…”

“…In this sense, definition of clinical criteria for resolution is difficult, and should be based on careful clinical evaluation. [5]…”

“…[15] In most cases addressed correctly, diagnosis is reached in approximately 3 months. [13] In the present case report, the time interval elapsed between emergence of lesions on skin and definition of diagnosis based on oral lesions was 5 months.…”

Paracoccidioidomycosis manifested by sarcoid-like cutaneous lesions with severe systemic disease: a rare and challenging diagnosis

“…Chronic PCM manifests progressively and may occur years after exposure to Paracoccidioides, caused by reactivation of the latent endogenous focus of quiescent yeast forms inside granulomas 2 , 4 , 5 . This form is classified as unifocal when one organ or system is impaired, and multifocal, characterized by the involvement of more than one organ such as the adrenal glands, central nervous system, mucous membranes, lymph nodes, or skin, as reported here 3 , 5 , 8 .…”