Paracoccidioidomycosis constitutes a fungal infection, caused by Paracoccidioides brasiliensis and Paracoccidioides lutzii. This condition is prevalent in Central and South America and can affect multiple systems.
Paracoccidioidomycosis is observed both in juvenile and adult patients, with the two types of the disease having considerably distinct characteristics in terms of clinical presentation. The juvenile form can assume an acute or subacute course; a plethora of disseminated skin lesions appear within some weeks or months following the inoculation of P. brasiliensis . Lesions can develop in any region of the body, but are primarily found on the face, neck, torso and perioral areas; these are typically ulcerated or vegetative   . The cases also present with hepatomegaly and lymphadenopathy, while sinus tracts are occasionally formed in the location of the enlarged lymph node. Constitutional symptoms such as malaise, fever, and loss of weight can also accompany the main infection signs. Involvement of the respiratory tract with corresponding complaints is rare but has been observed.
Adult paracoccidioidomycosis is typically chronic and may lead to the involvement of multiple organ systems. Lymphadenopathy is a significant finding and every lymph node may be affected; cervical lymph nodes are involved in the majority of the cases. Polymorphic skin lesions are usually restricted to the face and have a variable morphology. Other features that are frequently observed include those arising from the respiratory tract, such as a cough and dyspnea, as well as malaise and fever. Emphysema, pulmonary fibrosis, and bullae are direct complications and may play a significant role in the development of cor pulmonale and pulmonary hypertension in a minority of the cases. Laryngeal or pharyngeal lesions may complicate the clinical picture, with patients presenting acutely due to stridor, dysphagia, and dysphonia. Aguiar-Pupo stomatitis is another potential sign and involves concurrent nasal and pharyngeal ulceration, alongside lymphadenopathy that affects the cervical or mandibular lymph nodes. Additional symptoms encompass adrenal gland insufficiency that can be exacerbated by an Addisonian crisis (rare), bowel obstruction due to mesenteric lymph node enlargement, abdominal cramps, and hepatosplenomegaly. Central nervous system (CNS) involvement remains a characteristic that includes only the adult disease type and may cause meningitis and encephalitis   .
Patients with a suspected paracoccidioidomycosis require an extensive workup, with an aim to confirm the infection and investigate the systems affected. Due to the fact that culture sensitivity is low and requires up to 30 days in order to render results, the most efficient and common way to diagnose the specific infection is via direct visualization of yeast in preparations collected from various regions, including cutaneous lesion scrapings, sputum or tissue per se . Immunodiffusion and counterimmunoelectrophoresis can also be employed, as they both yield a satisfactory sensitivity of 80% and a specificity that exceeds 90%. The aforementioned techniques can also contribute greatly in terms of screening and follow-up. Solid-phase immunoassays can usually detect anti-gp43 antibodies in the serum and have a significant specificity and sensitivity.
The workup of pediatric patients also comprises a complete blood count, as hemoglobin is usually low and eosinophil counts are elevated. Hypergammaglobulinemia is a frequent pathological finding. Radiographs are indispensable, as the potential lymph node involvement requires accurate depiction and pulmonary function tests are also carried out to diagnose obstruction.
Adults may be eligible candidates for thoracic radiographs or computerized tomography scans (CT scans), as chronic paracoccidioidomycosis can lead to the formation of pulmonary infiltrates in the basal and/or central pulmonary regions . A CT or magnetic resonance imaging (MRI) scan can also help to eliminate other conditions that can lead to similar symptomatology. Findings that suggest a possible paracoccidioidomycosis-induced CNS pathology should also be investigated via a brain CT scan or MRI scan .