Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases

Photodynamic therapy in the treatment of oral lesions caused by paracoccidiomycosis

Paracoccidioidomycosis (PCM) is an endemic disease caused by the dimorphic fungus Paracocdioides brasiliensis and Paracoccidioides lutzii. Oral ulcers are usually the first clinical signs of the disease. As it is a systemic fungal disease, local treatments are considered complementary, such as photodynamic therapy (aPDT). We present a patient with ulcerated lesions in the oral cavity of about 6 months duration. The pain complaint in the oropharynx led to a reduction in food acceptance and a weight loss of around 40 kg. He underwent biopsy of the lip lesion, and the histopathological report described yeast with multiple buds compatible with PMC. Our team opted for treatment with aPDT sessions. Two sessions were carried out in the ward and six in the ICU, showing satisfactory results in the remission of ulcerated lesions associated with PCM as well as the painful symptoms in the oral cavity. Also, the patient underwent Amphotericin B and Sulfamethoxazole-trimethoprim. We believe that the association of aPDT with pharmacological therapy possibly accelerated the repair process of oral lesions, as well as providing fungal lesion decontamination, improving progressively the healing of oral lesions.