Paracoccidioidomycosis Mimicking Squamous Cell Carcinoma on the Dorsum of the Tongue and Review of Published Literature

• Published in: Mycopathologia (1975) 2014-06, Vol.177 (5-6), p.325-329
• Main Authors: Pedreira, Renato do Prado Gomes, Guimarães, Eduardo Pereira, de Carli, Marina Lara, Magalhães, Evandro Monteiro de Sá, Pereira, Alessandro Antônio Costa, Hanemann, João Adolfo Costa
• Format: Article
• Language: English
• Subjects: Aged; Antifungal Agents - therapeutic use; Biomedical and Life Sciences; Biopsy; Brazil; Cancer; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - microbiology; Carcinoma, Squamous Cell - pathology; Case reports; Chronic obstructive pulmonary disease; Connective tissue; Eukaryotic Microbiology; Fungi; Humans; Hypotheses; Itraconazole - therapeutic use; Life Sciences; Male; Medical Microbiology; Microbial Ecology; Microbiology; Mycobacterium; Paracoccidioides - isolation & purification; Paracoccidioides - physiology; Paracoccidioides brasiliensis; Paracoccidioidomycosis - diagnosis; Paracoccidioidomycosis - drug therapy; Paracoccidioidomycosis - microbiology; Paracoccidioidomycosis - pathology; Patients; Plant Sciences; Tongue; Tongue Diseases - diagnosis; Tongue Diseases - drug therapy; Tongue Diseases - microbiology; Tongue Diseases - pathology; Tuberculosis; Ulcers
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-014-9739-3

Introduction Paracoccidioidomycosis is a disease that is endemic to southern and southeastern Brazil, caused by the fungus Paracoccidioides brasiliensis . The most common clinical oral manifestation is the presence of multiple granulomatous ulcers with hemorrhagic dots, located mainly on the lips, palate, and buccal mucosa. However, the disease can manifest atypically as a single ulcer, mimicking oral squamous cell carcinoma (SCC) or tuberculosis. Case report A 65-year-old male patient presented with a complaint of a single ulcerated lesion on the dorsum of the tongue; the lesion had evolved over 6 months. The diagnostic hypotheses were SCC and oral manifestation of tuberculosis. An incisional biopsy was performed, and histopathological analysis of the specimen revealed pseudoepitheliomatous hyperplasia, a granulomatous structure of epithelioid histiocytes, multinucleated giant cells, and lymphocytes in the connective tissue. Grocott staining confirmed the presence of the fungus in the lesion, and a diagnosis was made of paracoccidioidomycosis. The patient was treated with 200 mg/day of itraconazole for 12 months and now shows no signs or symptoms of recurrence of the disease. Conclusion Correct diagnosis is essential for a successful therapeutic approach and resolution of the lesion.