By Gary M. White, MD
Ulceration, edema, and destruction of the oral mucosa is characteristic. Also known as South American blastomycosis, this disease Is most common in Southern Mexico, Argentina, Uruguay, Brazil, Colombia, Venezuela, and Argentina. Poor rural workers are most commonly affected. In the tissue phase, the organism Paracoccidioides brasiliensis forms a pilot wheel (mother cell with several peripheral buds connected by narrow necks). It grows in Sabouraud medium at 25-28 degrees after 3-4 weeks. The initial portal of entry is thought to be the lung although direct cutaneous inoculation has been reported.
In the acute form of the disease, multiple ulcerated acneiform papules, scrofuloderma, and/or subcutaneous cold abscesses may occur. In the chronic form, oropharyngeal lesions are frequent often consisting of shallow ulcers with a granulomatous base. Progression may occur with destruction of the uvula or epiglottis or loss of teeth. Reddish, firm edema of the lips may occur. Infiltration and destruction of the nose similar to that which occurs in American cutaneous leishmaniasis may occur. Systemic involvement typically involves the adrenal glands, lymphatics, GIT, or bone.
Diagnosis can be by culture of exudate, sputum, bronchial washings, pus, or tissue biopsy. Microscopic examination of wet preparation using KOH may show the organism.
This disease is fatal without treatment. The latest infectious disease treatment guidelines should be consulted.
Arch Dermatol. 2009;145(11):1325-1330
Anais Brasileiros de Dermatologia. 2013;88(5):700-711
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