The fungus normally is found in soil and is acquired by inhalation. Rarely, it is acquired by direct inoculation into the skin or mucosa from infected plant matter. The disease can manifest in 4 clinical forms: pulmonary, mucocutaneous, lymphatic, and mixed.
Pulmonary infection is the most common and is found in 70%-80% of patients. Disease is localized to the lung in 25% of cases. This is followed by dissemination to the skin and mucosa (around the pharynx, the mouth, and occasionally the anus), lymphatic system (especially cervical nodes), adrenal glands, liver, spleen, central nervous system (brain lesions [abscess, granuloma, nodule, or cyst] or less commonly meningitis), and bones. The clinical course is usually chronic and progressive over months to years, with associated weight loss and chronic cough.
In travelers to endemic areas, the mean time to presentation was 15 years, suggesting a long dormancy before disease presentation.
B41.9 – Paracoccidioidomycosis, unspecified
59925007 – Paracoccidioidomycosis
Differential Diagnosis & Pitfalls
- Hantavirus pulmonary syndrome
- Cutaneous leishmaniasis
- Mucocutaneous leishmaniasis
- Ulcerative tuberculosis (TB)
- Granulomatosis with polyangiitis
- Squamous cell carcinoma