Aplicação da ultrassonografia para análise da extensão de lesões bucais da Paracoccidioidomicose

Resumo (EN)

Paracoccidioidomycosis is the most common endemic systemic fungal infection in Brazil. It is quite rare in women, possibly due to estrogen acting as a protective factor. Oral and/or oropharyngeal lesions can be observed in 60% of infected individuals, aiding in the diagnosis of paracoccidioidomycosis. This study presents the case report of a 75-year-old white female seamstress who sought dental care due to painful symptoms from a diffuse ulcerated lesion with a mulberry-like surface appearance, firm to palpation. The lesion was located in the region of the right buccal mucosa, tonsillar pillar, lower lip, vestibular fornix, alveolar ridge, and floor of the mouth. Multislice computed tomography revealed involvement of 75% of the lungs with nodular hyperdense areas. Intraoral ultrasound examination showed absence of epithelium and a well-defined hypoechoic area with positive Doppler signal at the periphery in the buccal mucosa. Mixed images (hypoechoic/hyperechoic) with negative Doppler signal and invasion into the underlying muscles were observed in the floor of the mouth, suggesting an infectious process. The differential diagnoses included tuberculosis and paracoccidioidomycosis. Incisional biopsies were performed, and histopathological examination revealed Paracoccidioides brasiliensis. The patient was referred to the Infectious Diseases Service and received treatment with itraconazole. After one year, the patient remains in good general condition with the fungal infection under control. Ultrasound was crucial as it demonstrated distinct behavior of the lesions and facilitated selection of biopsy sites.