Rare clinical presentations of paracoccidioidomycosis: Epidemiological, clinical, and microbiological insights from a Brazilian reference center.

backgroundParacoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America, caused by species of the Paracoccidioides brasiliensis complex. Involvement of the eyelid, genital, and osteoarticular systems in PCM is rare.

objectivesThis study describes the epidemiological, clinical, and microbiological characteristics of rare presentations of PCM involving the eyelids, genital system, and osteoarticular system in patients treated at a reference center in southeastern Brazil.

methodsA retrospective cross-sectional analysis was conducted among 33 patients diagnosed with uncommon forms of PCM, proven or probable, between 1973 and 2020. Demographic, clinical, and therapeutic data were retrieved from medical records.

resultsBetween 1973 and 2020, 33 patients with rare forms of PCM were identified in Espírito Santo, Brazil, involving the eyelid (n = 11), genital (n = 10), and osteoarticular (n = 12) systems. Most patients were male and had rural exposure. Eyelid and genital involvement occurred in middle-aged men with chronic disease and frequent pulmonary association, with ulcerative lesions predominating. Osteoarticular cases affected younger patients with acute/subacute forms and systemic symptoms. Radiological findings mainly included osteolytic lesions. Histopathology showed high diagnostic yield, while serology was frequently positive. Treatment varied by severity, and relapses were associated with irregular therapy.

conclusionsThese findings expand the clinical spectrum of PCM and highlight the importance of recognizing atypical localizations that may mimic neoplastic or other infectious diseases. Awareness of these rare manifestations, particularly in endemic areas, can improve diagnostic accuracy and patient outcomes.