title: [Skin and mucous membrane manifestations of coccidioidomycosis: a study of thirty cases in the Brazilian states of Piauí and Maranhão].
abstract: BACKGROUND
  Coccidioidomycosis is a systemic mycosis that usually presents as a benign infection. Patients generally recover spontaneously; however, a small proportion of infected individuals develop progressive complications that may affect the skin in the form of disseminated pleomorphic lesions and may become fatal.
  
  
  OBJECTIVE
  To identify and describe skin and mucous membrane manifestations of coccidioidomycosis, to identify occupational hazards associated with the disease and to determine its associated clinical presentation.
  
  
  METHODS
  A study conducted between 2003 and 2006 involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination.
  
  
  RESULTS
  Extrapulmonary lesions were found in 13 cases (43.3%), consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6%), exanthema with erythematosquamous lesions (26.6%) and erythema multiforme (23.3%), as well as ulcerations of the tongue (13.3%), lip ulcers (6.6%) and subcutaneous abscess (3.3%). These manifestations were seen during the acute phase of the disease.
  
  
  CONCLUSIONS
  Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation.
authors.affiliation: Hospital Getulio Vargas, Universidade Federal do Piauí, Teresina, PI, Brasil.
authors.forename: Antônio de
authors.initials: Ad
authors.lastname: Deus Filho
authors.forename: Antônio Castelo Branco de
authors.initials: AC
authors.lastname: Deus
authors.forename: Alisson de Oliveira
authors.initials: Ade O
authors.lastname: Meneses
authors.forename: Andressa Sobral
authors.initials: AS
authors.lastname: Soares
authors.forename: Aécio Lopes de Araújo
authors.initials: AL
authors.lastname: Lira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003047:Coccidioidomycosis / Q000175:diagnosis*; D003881:Dermatomycoses / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000382:microbiology*; D011446:Prospective Studies; D055815:Young Adult