Disseminated paracoccidioidomycosis

**Definition:** Disseminated paracoccidioidomycosis results from haematogenous and lymphatic dissemination of yeasts from the lungs and aerodigestive tract. Cutaneous involvement, seen in 25% of cases, presents as crusted papules, ulcers, nodules, and verrucous plaques. Lymphadenopathy occurs commonly in the cervical region, but all lymph node chains can be involved. Adrenal glands are commonly affected with a significant risk of adrenal insufficiency and Addisonian crisis. Long bones such as ribs, humeri, and clavicles can be involved. Mesenteric lymph node involvement can lead to bowel obstruction. Meningoencephalitis occurs in up to one quarter of cases.

**Long definition:** Chronic paracoccidoidomycosis involving more than one organ or system. The lungs are affected in the majority of cases, with dry cough and dyspnoea the most frequent presenting symptoms. Mucosal involvement occurs in 30-50% of cases: the mouth (oropharynx, lips, tongue, gingiva, palate) and larynx are the most frequently affected sites. Skin lesions may be represented by a large variety of patterns including papules, nodules, ulcers and verrucous plaques. Adrenal involvement is frequently found and may result in acute or chronic hypoadrenalism. Central nervous system invasion occurs in up to 20% of patients, mostly commonly as an expanding granulomatous mass.

**Inclusions:** - Disseminated paracoccidioidomycosis with central nervous system involvement - Disseminated paracoccidioidomycosis without central nervous system involvement