Oral paracoccidioidomycosis as a differential diagnosis of oral cancer

Abstract

A 40-year-old Caucasian man presented with a symptomatic large ulcer in his tongue, with a granular purpuric surface, which appeared 3 months before admission to the outpatient clinic [Minas Gerais, Brazil]. He also complained of weight loss, fever and anorexia. He has been a smoker and an alcohol addict for 25 years. Intraoral examination showed mulberry-like granulomatous lesions on the border of the tongue measuring about 4.0 cm. In addition, there was a gingival linear erythema dispersed in the maxilla. The diagnostic hypothesis was squamous cell carcinoma. Exfoliative cytology revealed spherullous, birefringent and multiple-budded fungi (Paracoccidioides brasiliensis) surrounded by Langhan's giant cells, epithelioid cells and nonspecific inflammatory cells. Biopsy specimens completed the cytological evaluation and showed granuloma with multinucleated giant cells and polymorphonuclear cells with vacuoles suggestive of infection. The diagnosis was oral paracoccidioidomycosis. Itraconazole (300 mg) was given daily for 12 months. In 24-month follow-up, there was no evidence of disease.