Paracoccidioidomycosis with sarcoid-like cutaneous lesion: A clinicopathological challenge

Paracoccidioidomycosis: An atypical presentation in an immunocompetent woman

“… 8 Lung involvement was absent, as is expected with this rare vegetating subtype of primary cutaneous PCM, characterized by a scarcity of fungal structures accompanying the observed classic granulomatous infiltrates. 9 Interestingly, in contrast, our patient had significant lung involvement and resultant shortness of breath, which suggests that this vegetating presentation of PCM may not be a skin-limited disease as reported in the current literature, 10 but may also occur with disseminated PCM with skin infiltration.…”

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 .…”

“…Consequently, histology reveals tuberculoid granulomas with a paucity of fungi, while serology is usually characterized by low titers or negative results. Because of these factors, the disease presents diagnostic challenges and is often misdiagnosed as other granulomatous diseases, such as leishmaniasis, granulomatous rosacea, tuberculoid leprosy, and sarcoidosis 3 . The fungi may present in the pathognomonic form with multiple exosporulation patterns (resembling a "Ship's Wheel" or "Mickey Mouse") or as a non-sporulating form with a thick wall, requiring other diagnostic methods (culture, serology or molecular biology) to identify Paracoccidioides , as was done in this study 5 .…”

“…These show variable morphology, and may occur as ulcers, papules, nodules, and vegetative, verrucous, or infiltrative plaques. A rare pattern described as infiltrated or lichenoid lesions, namely sarcoid or sarcoidosis-like is also reported 3,7 . Usually, this clinical expression is almost exclusively cutaneous, and histology reveals a tuberculoid granuloma with a scarcity of fungi, leading to its misdiagnosis as other granulomatous diseases 1 .…”

“…PCM is transmitted via inhalation of soil-borne propagules. The outcome, whether spontaneous cure, active disease, or latent disease, depends on the interaction between host immunity and fungal virulence 2 , 3 .…”