Introduction: Paracoccidioidomycosis (PCM) is the most common systemic mycosis in Latin America. Case: A 16-year-old female patient from Bolivia presented with a 6-month history of ulcerative nasal lesions and cervical lymphadenopathy. Initial histopathology suggested tuberculosis with a positive Ziehl-Neelsen stain. Direct KOH examination revealed characteristic "steering wheel" yeasts of Paracoccidioides brasiliensis. Antituberculosis treatment was discontinued and itraconazole was started with a favorable response. Discussion: Juvenile paracoccidioidomycosis represents a significant diagnostic challenge due to its variable clinical presentation and its ability to mimic other more prevalent pathologies such as tuberculosis and lymphoproliferative syndromes. This case illustrates the importance of maintaining a high index of clinical suspicion in adolescent patients from endemic areas who present with lymphadenopathy and mucocutaneous lesions, especially when tuberculosis studies are negative. A broad differential diagnosis is important, as is the need for specific complementary testing in the event of clinical discrepancies. Direct mycological examination is crucial as a rapid and definitive diagnostic method for paracoccidioidomycosis.
