title: Photodynamic inactivation of oral paracoccidioidomycosis affecting woman with systemic lupus erythematosus: An unusual case report.
abstract: Paracoccidioidomycosis (PCM) is a systemic disease caused by the dimorphic fungus Paracocdioides brasiliensis. The infection primarily reaches the lungs by the inhalation of fungi spores and later can disseminate to other organs causing secondary oral lesions. Systemic lupus erythematosus (SLE), on the other hand, is an autoimmune chronic inflammatory disease that affects various organ systems, including skin and oral cavity. Here we report a 39-year-old female patient bearing SLE and presenting an ulcerated lesion on the hard palate extending to the superior alveolar ridge, diagnosed as PCM. Itraconazole 200mg was prescribed and photodynamic therapy (PDT) was also instituted in a way to help dealing with the PCM infection while assisting such an immunocompromised patient to heal. PDT consisted of topically placing toluidine blue dye at 37.5mg/L for 5min, followed by low-level laser irradiation (660nm; 100J/cm2; 40mW of power; 100s per point). Forty days after beginning the treatment, the patient showed total regression of the oral lesion and absence of painful symptoms. The serologic test was performed again after six months of therapy and was negative; the patient continues to be followed periodically.
authors.affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: cinthiamribeiro@hotmail.com.
authors.forename: Cínthia Magalhães
authors.initials: CM
authors.lastname: Ribeiro
authors.affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: clenivaldodentista@yahoo.com.br.
authors.forename: Clenivaldo Alves
authors.initials: CA
authors.lastname: Caixeta
authors.affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: marinadentista@gmail.com.
authors.forename: Marina Lara
authors.initials: ML
authors.lastname: de Carli
authors.affiliation: Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: ffsperandio@gmail.com.
authors.forename: Felipe Fornias
authors.initials: FF
authors.lastname: Sperandio
authors.affiliation: Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, Brazil. Electronic address: monteiromagalhaes@oi.com.br.
authors.forename: Evandro Monteiro
authors.initials: EM
authors.lastname: de Sá Magalhães
authors.affiliation: Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: alessandro.unifal@uol.com.br.
authors.forename: Alessandro Antônio
authors.initials: AA
authors.lastname: Costa Pereira
authors.affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700-Alfenas, MG, 37130-000, Brazil. Electronic address: jachanemann@uol.com.br.
authors.forename: João Adolfo
authors.initials: JA
authors.lastname: Costa Hanemann
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D010229:Paracoccidioidomycosis / Q000188:drug therapy* / Q000453:epidemiology; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D014048:Tolonium Chloride / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D017319:Photosensitizing Agents; D014048:Tolonium Chloride; D017964:Itraconazole
keywords: Antimicrobial; Paracoccidioides brasiliensis; Paracoccidioidomycosis; Photodynamic therapy; Systemic lupus erythematosus; Women