Paracoccidioidomycosis lesions

Diagnosis: Paracoccidioidomycosis lesions

Clinical Presentation

Paracoccidioidomycosis lesions

Clinical History

Mucocutaneous lesions (oral, nasal, laryngeal) with pulmonary symptoms. Travel/residence in Latin America. Agricultural exposure.

Treatment

Mild-moderate: itraconazole 200mg/day × 6-18 months. Severe/disseminated: amphotericin B followed by itraconazole. TMP-SMX as alternative. Long treatment courses needed.

Differential Diagnosis

• Squamous cell carcinoma • Leishmaniasis • Lymphoma • Sarcoidosis • Wegener granulomatosis (GPA) • Tuberculosis • Histoplasmosis

Key Learnings

• Caused by Paracoccidioides brasiliensis — endemic to Latin America • "Captain's wheel" or "Mickey Mouse ears" — multiple budding yeast (pathognomonic on histology) • Mulberry-like or moriform stomatitis — hemorrhagic, vegetating mucosal lesions • Pulmonary involvement is primary; cutaneous lesions represent hematogenous spread • Most patients: adult males with agricultural exposure in Latin America • Acute/subacute (juvenile) form: lymphadenopathy, hepatosplenomegaly • Chronic (adult) form: pulmonary + mucocutaneous disease

Tags: dermatology, kodachrome, Paracoccidioidomycosis lesions