Paracoccidioidomycosis in an immunocompetent adult mimicking a facial verrucosus carcinoma

Summary: Paracoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America and the most common one in Paraguay, caused by the thermodimorphic fungus Paracoccidioides brasiliensis. Most of the cases occur in the chronic form, which predominantly affects male farmers. We present the case of a 66-year-old male farmer, with no underlying pathology, from a rural area, who consulted for a growth of a pre-existing facial lesion in the nasolabial furrow, without reporting other symptoms. Suspecting squamous cell carcinoma, a biopsy was performed, which revealed granulomatous inflammation with the presence of fungal spores and multiple exosporulations, PAS-positive. On the follow-up visit, a firm, mulberry-like lesion was observed on the oral mucosa. Direct examination with potassium hydroxide revealed spores with multiple budding. Chest X-ray showed mild interstitial infiltration in both lungs. The diagnosis of chronic multifocal PCM was made, and the patient was treated with itraconazole, showing good response. This case illustrates the importance of clinical suspicion, direct examination, and histopathology in diagnosing. When the cutaneus manifestation is single, others lesions, must be included in the differential diagnosis. Should be considered within the differential diagnosis of the verrucous syndrome in endemic areas, and also in other continents as a result of migratory phenomenon.