Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy

Marques, Sílvio Alencar; Lastória, Joel Carlos; Putinatti, Maria Stella de Mello Ayres; Camargo, Rubens de Figueiredo; Marques, Mariângela Esther Alencar

doi:10.1590/s0036-46652008000100010

Cited by 23 publications

(36 citation statements)

References 10 publications

(13 reference statements)

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“…Clinical and histopathological misdiagnosis may occur due to similarities among cutaneous sarcoidosis, infiltrative PCM and the tuberculoid leprosy. 1 A similar diagnostic mistake regarding pulmonary lesions was described recently in literature. Coelho et al (2015) reported 8 cases of pulmonary and disseminated PCM with prior histopathological diagnosis of sarcoidosis (noncaseating granulomas in lung biopsies).…”

Section: Discussionsupporting

confidence: 61%

“…3 Regarding histopathology, noncaseating granulomas of epithelioid cells with pale-staining nuclei and a rim of few number of lymphoid cells surrounding the granuloma, the naked tubercle, is suggestive of sarcoidosis. 1 In PCM, hematoxylin and eosin (H&E) stained sections usually show a mixed suppurative and granulomatous inflammatory infiltrate composed primarily of neutrophils admixed with epithelioid histiocytes. Nevertheless, a noncaseating epithelioid granuloma, similar to those found in sarcoidosis, can be observed.…”

Section: Discussionmentioning

confidence: 99%

“…3 In a country where leprosy is still a public health problem and the primary care physician is instructed to be alert to that disease, misdiagnosis between infiltrative PCM and tuberculoid leprosy could be understood as acceptable at the first moment. 1 Marques et al (2008) reported a case of PCM misdiagnosed as tuberculoid leprosy, that he called sarcoid-type PCM. He emphasized that histological diagnosis of granulomatous infectious diseases will be accurate when there are characteristic microscopic features or sufficient number of infectious agents to be detected by histochemistry analysis.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,3 In the past, PCM was thought to be caused by P. brasiliensis, but a new species, P. lutzii, was discovered in the central-western region of Brazil. 3 P. lutzii is composed of a single monophyletic and recombining population so far found in central, southwest, and north Brazil and Ecuador.…”

Section: Introductionmentioning

confidence: 99%

“…4 The fungus lives in the soil and usually infects the patient through inhalation of airborne propagules, the lungs being the portal of entry. 1,5 In areas of larger endemicity, such as Brazil, the annual incidence reaches 3 cases per every 100,000 inhabitants. 6 Cutaneous lesions in PCM are frequent and ulcer or ulcerous-vegetative lesions are the commonest morphological type followed by the infiltrative pattern.…”

Section: Introductionmentioning

confidence: 99%

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Sarcoid-like paracoccidioidomycosis: case report

Athayde¹,

Nacif²,

Lupi³

et al. 2017

Medicina (Ribeirão Preto)

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RESUMO:Importância do problema: Paracoccidioidomicose (PCM) é a micose sistêmica mais prevalente em indivíduos imunocompetentes no Brasil, sendo causado pelo fungo dimórfico Paracoccidioides spp. O fungo vive no solo e geralmente sua porta de entrada no paciente ocorre pelos pulmões por inalação de propágulos presentes no ar. Em áreas de maior endemicidade, como no Brasil, a incidência chega a três casos por 100 mil habitantes. As lesões cutâneas na PCM são frequentes. Lesões ulceradas ou ulcerovegetantes são os tipos morfológicos mais comuns, sendo o padrão infiltrativo o segundo mais descrito.A histologia demonstra inflamação granulomatosa na derme. A PCM infiltrativa pode ser facilmente confundida com sarcoidose, visto que ambas possuem similaridades clínicas e histopatológicas.Comentários: Nós descrevemos um caso de PCM cutânea com diagnóstico inicial incorreto de sarcoidose, tanto pelo quadro morfológico, como pelo exame histopatológico semelhante. Exames posteriores revelaram a presença de Paracoccidioides sp na coloração pelo Grocott e na cultura do material para fungos. Os autores acreditam que esse caso possa ajudar médicos a suspeitarem e considerarem PCM no diagnóstico diferencial de lesões cutâneas infiltrativas, especialmente se houver história epidemioló-gica de viagem a área endêmica ou resposta insatisfatória ao tratamento para sarcoidose. Palavras

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sarcoid-like paracoccidioidomycosis: case report

Athayde¹,

Nacif²,

Lupi³

et al. 2017

Medicina (Ribeirão Preto)

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Eyelid and conjunctival paracoccidioidomycosis simulating carcinoma

Odashiro

Odashiro²,

Fernandes³

et al. 2010

Int Ophthalmol

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Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in immunocompetent individuals in Brazil. Ocular infection by PCM is rare; however, when infection does occur, the most common ocular sites involved are eyelid and conjunctiva. A 68-year-old white male presented with a 2-month history of a painless, ulcerated, infiltrative and diffuse whitish lesion located on the right inferior eyelid. A clinical diagnosis of malignant tumor, possibly squamous cell carcinoma, was made. The histopathologic examination showed a hyperplastic epithelium with inflammatory infiltrate of lymphocytes, plasma cells, neutrophils and histiocytes. Large numbers of giant cells were also present. Periodic acid Schiff and Grocott (silver methenamine) stains showed several large round structures with peripheral lateral small budding cells that resembled a "ship's wheel". No multinucleated fungi were seen. The fungi varied in size and small forms were round and single fungal structures. A diagnosis of paracoccidioidomycosis was made PCM eyelid infection is rare and can simulate carcinoma both clinically and histopathologically.

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Single Oral Paracoccidioidomycosis Mimicking Other Lesions: Report of Eight Cases

et al. 2011

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Paracoccidioidomycosis is a fungal infection caused by Paracoccidioides brasiliensis. It is an endemic disease, representing a serious health problem in Latin American countries. This infection primarily affects the lungs and is acquired by inhalation of the fungus. It can spread to other organs and tissues, mainly the oral cavity affecting more adult men from 30 to 50 years of age. On clinical presentation, several signs associated with impaired general and nutritional conditions can be noted. Oral manifestation is more common in the soft palate, gingiva, lower lip, buccal mucosa, and tongue. The classical clinical presentation is a superficial ulcer with granular appearance and hemorrhagic points. Usually, the oral lesion is extensive and generalized. Although uncommon, when the oral manifestation is single, others lesions, particularly squamous cell carcinoma, must be included in the differential diagnosis. In this article, the authors discuss the unusual presentation of eight cases of single oral paracoccidioidomycosis and its diagnostic importance.

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Paracoccidioidomycosis: infiltrated, sarcoid-like cutaneous lesions misinterpreted as tuberculoid leprosy

Cited by 23 publications

References 10 publications

Sarcoid-like paracoccidioidomycosis: case report

Sarcoid-like paracoccidioidomycosis: case report

Eyelid and conjunctival paracoccidioidomycosis simulating carcinoma

Single Oral Paracoccidioidomycosis Mimicking Other Lesions: Report of Eight Cases

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