Paracoccidioidomycosis mimicking squamous cell carcinoma on the dorsum of the tongue and review of published literature.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
Correct diagnosis is essential for a successful therapeutic approach and resolution of the lesion.
Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, CEP 37130-000, Brazil, renatopedreira@hotmail.com.
Renato do Prado Gomes
Rdo P
Pedreira
Eduardo Pereira
EP
Guimarães
Marina Lara
ML
de Carli
Evandro Monteiro de Sá
EM
Magalhães
Alessandro Antônio Costa
AA
Pereira
João Adolfo Costa
JA
Hanemann
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D010228:Paracoccidioides / Q000302:isolation & purification / Q000502:physiology*; D010229:Paracoccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D014060:Tongue Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*
D000935:Antifungal Agents; D017964:Itraconazole