Labial lesion in a Portuguese man returned from Brazil - The role of molecular diagnosis

Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by the fungus Paracoccidioides. Two species are recognized as causing paracoccidioidomycosis: Paracoccidioides brasiliensis and Paracoccidioides lutzii. Paracoccidioidomycosis is a commonly diagnosed fungal infection in South America and rare in Europe. Nevertheless, with the increase of immigration from endemic regions to European countries, clinicians must be aware of tropical infections and strongly consider them in differential diagnosis, having therefore the knowledge of all the available means necessary to identify specific pathogens. The authors present a case report of a Portuguese 46-year-old man who lived in Itaipava-Brazil for the past 21 years. In his return to Portugal, presented a lip lesion, weight loss, pulmonary infiltrates and cavities, and generalized adenopathies. An histopatologic diagnosis of mucocutaneous and pulmonary cryptococcosis was initially made. However, the negative result of cryptococcal antigen and the patient's epidemiology lead to the hypothesis of other etiological agent. All cultural examinations were negative, however the molecular detection of fungal DNA directly from tissue samples allowed the identification of the correct etiological agent as Paracoccidioides brasiliensis and the introduction of a most effective treatment for the management of this fungal infection. This was the first time that Paracoccidioides brasiliensis was identified by this PCR technique in Portugal.