Oral paracoccidioidomycosis - a rare but frequent disease in Brazil: A short case series

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology Vol. 138; no. 2; p. e65
• Main Authors: Nogueira, Mr. Julio Cesar Paiva, Arantes, Ms. Kenya Lara Benincasa Firmino, Ferrari, Ms. Paula Tamanini, Dias, Ms. Brenda Naconechny Betero, Veras, Mr. Lucas Luis Sousa, Teixeira, Mr. Gustavo Ramos, Losada, Dr. Daniele Moraes, Neto, Dr. Gustavo Ramos Tieghi, Coracin, Dr. Fabio
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2024
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2024.04.103

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by a dimorphic fungus and it represents a significant infection in tropical countries. Brazil is considered an endemic country, with a higher prevalence in the south, southeast, and midwest regions. The aim of this study was to evaluate the clinicopathologic features of a case series of oral PCM in a southwestern and north region of Brazil. A retrospective study was carried out and included 15 patients with oral biopsies diagnosed as PCM, between the years 2022 and 2023 at the Dental Service of the Barretos Cancer Hospital, Brazil. In all, both hematoxylin-eosin and Grocott staining reached the final diagnosis. 15 cases were retrieved in a single Institution in 3 states from Brazil. In all, 86,7% were male, with a mean age of 58 years (ranging from 30 to 66 years), 73.3% were in white people. Multiple lesions in a single patient were observed in 9 cases (60%) and a single lesion was observed in 6 cases (40%). The most common fundamental lesion found was ulceration (n=12; 80.0%), followed by nodule (n=3; 20%). The most affected sites were attached gingiva (33.3%) followed by floor of the mouth (20%), buccal mucosa (20%), lip mucosa (20%) and soft palate (20%). The mean time of diagnosis was 3 months. Histopathological features consisted of hyperplastic epithelium, intraepithelial microabscesses, and formation of granulomatous chronic inflammatory reaction in a fibrous connective tissue with severe chronic inflammatory reaction. Yeasts were observed inside of multinucleated giant cells or extracellularly. Also, Grocott's methenamine silver stain showing multiple, narrow-based budding yeast cells with steering wheels. PCM is rare, it should be included in diagnosis mainly multiple, ulcerated, erythematous, or granular lesions affecting preferentially the buccal mucosa, soft and hard palate, and gingiva.