PARACOCCIDIOIDOMYCOSIS WITH ORAL MANIFESTATIONS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

Abstract

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America, characterized by a chronic and insidious course, frequent diagnostic delays, and potential multisystem involvement. The chronic form generally results from reactivation of a latent pulmonary infection and often presents with extrapulmonary involvement, particularly affecting the oral mucosa, which may represent the main reason for seeking medical or dental care. PCM predominantly affects adult men, especially rural workers. Most patients are smokers and alcohol users, and a protective effect of 17β-estradiol partially explains its lower prevalence in women. Clinically, oral lesions present as painful ulcerations with a moriform (mulberry-like) appearance, most commonly involving the gingiva, palate, lips, and buccal mucosa, and may mimic infectious, inflammatory, or malignant conditions. Pulmonary lesions are the initial manifestation of the disease. Definitive diagnosis is based on mycological and histopathological identification of the etiological agent, Paracoccidioides spp., aided by special stains such as periodic acid–Schiff (PAS) and Grocott–Gomori methenamine silver. Early recognition of oral manifestations and diagnostic confirmation are essential to avoid misdiagnosis, ensure appropriate antifungal therapy, and prevent disease progression and severe systemic complications