Dados do Trabalho

Título

Sarcoidic-Like Paracoccidioidomycosis: A Clinical Case Report

Objetivos(s)

To present an unusual case of Paracoccidioidomycosis (PCM) manifesting as sarcoid-like skin lesions.

Relato do Caso

A 59-year-old woman presented an extensive ulcerated plaque with a sarcoid-like appearance on the scalp, preauricular and right mandibular region, with a duration of 14 years. She had previously been treated for tuberculoid leprosy without clinical response. Four years ago, she has been diagnosed with sarcoidosis based on clinical presentation and histopathological examination that reveals dense granulomas and absence of etiologic agent. She was treated with methotrexate, folic acid, and chloroquine diphosphate, showing slight improvement in the lesions but without complete resolution. Prednisone 40mg/day was initiated, and the patient experienced worsening and progressing of the skin lesions, affecting the trunk, buttocks, limbs, with lesions in the mouth and cervical lymphadenopathy. Direct mycological examination and histopathological analysis of a cervical lymph node biopsy revealed typical forms of Paracoccidioides spp. Chest tomography was normal. Treatment was initiated with intravenous administration of sulfamethoxazole+ trimethoprim for 10 days, followed by therapy with oral itraconazole 200mg/day and local dressing for the lesion on the scalp and face (cleansing with 0.9% saline solution and non-adherent mesh dressing changed every 48 hours). Mouth lesions and cutaneous lesions on the face, trunk, and limbs disapeared after 6 months of treatment. However, complete remission of the sarcoid-like lesion on the scalp occurred only in the 18th month of treatment. The antifungal treatment was discontinued after 32 months of use. Currently, the patient continues to be monitored as an outpatient, in the apparent cure stage, awaiting hair transplantation.

Conclusão

This case reinforces the importance of considering PCM as a clinical suspicion in cutaneous lesions with a clinical and histopathological appearance suggestive of sarcoidosis in endemic areas for PCM.

Agradecimentos

We thank the Rede de Apoio ao Diagnóstico de Infecções Fúngicas- RADIF.
This work received support from the CNPq