PMC7007017_01
Clinical aspect of the lesions. A - Infiltrated erythematous plaques with a sarcoid aspect on the earlobes and on the frontal, nasal, bilateral malar, and cervical regions. B - Intense edema in the pre-auricular region and left auricle, with ulceration extending to the retroauricular region, and synechia formation. Another infiltra ted and ulcerated plaque in the left temporal region is noted
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However, the cutaneous lesions evolved with painful ulcerations that had an unpleasant smell and a purulent secretion and were associated with a severe cervical lymph node enlargement (Figure 1).
Mycological examinations of paracoccidioidomycosis. A. Direct mycological observation through optical microscopy (X200) with 10% KOH, showing birefringent yeasts with multiple buds. B. Fungal culture in Sabouraud medium showing the growth of a fila mentous colony with a rough aspect at 25oC
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In the direct mycological examination, the presence of isolated and rare yeasts with multiple buds, suggestive of Paracoccidioides sp. (Figure 2), was observed. Fungal cultures of the samples collected from ulcers and lesions presented growth of Paracoccidioides sp. (Figure 2).
A. The histological section revealed a granulomatous nodular dermatosis compromising the entire dermis. Few portions of the epi dermis were acanthotic and no pseudoepitheliomatous hyperplasia was observed (Hematoxylin & eosin, x25). B. A yeast with multiple buds is observed within the granuloma (arrow) (Hematoxylin & eosin, x400). C. Yeasts with multiple buds in the granuloma (Grocott stain, x400)
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Histopathological examination revealed a histiocytic reaction with epithelioid granulomas and multinucleated giant cells that contained multiple bud-yeast structures (Figure 3).
Clinical aspect of the lesions after eight months of treat ment showing scaring lesions
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The patient evolved with a gradual improvement, during which only scarring lesions could be observed (Figure 4).