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60 year old man with ulcerated lesions of the right eyelid
Digital Journal of Ophthalmology 1996
Volume 2, Number 8
November 27, 1996
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J Oscar Croxatto, MD | Fundacion Oftalmologica Argentina Jorge Malbran
Ricardo Negroni, MD | Hospital Municipal F. J. Muiz
Gabriela Volpe, MD | Hospital Oftalmologico Santa Luca
Diagnosis and Discussion
Paracoccidioidomycosis (South American Blastomycosis)

Culture of the patient's sputum and bronchoalveolar washings grew Paracoccidioides brasiliensis. Cultures for mycobacteria gave negative results. The patient was started on oral Itraconazole 100 mg/day.

Paracoccidioidomycosis (Lutz-Splendore-Almeida's disease) is a granulomatous diseases caused by the dimorphic fungus Paracoccidioides brasiliensis. The infection is endemic in tropical and subtropical regions of South America, and may be seen in Central America, Mexico, and Africa. Occasional cases have been observed in the United States in patients traveling FROM countries where this mycosis is endemic. Male rural workers FROM 30 to 60 years of age constitute the population at risk. Paracoccidioides is most frequently acquired by inhalation of the organism. The primary lung infection may be asymptomatic and then disseminate to involve mucous membranes, lymph nodes, and other organs. The mucosal lesions are ulcerative with a serpiginous active border and a crusted surface. Microscopic examination is important for the diagnosis of paracoccidioidomycosis. Characteristic findings include large, round or oval, multiple budding yeast cells, 5 to 20 ┬Ám in diameter, that occasionally may resemble a ship's wheel. Nonbudding cells may resemble Blastomyces dermatitidis, Histoplasma and Coccidioides. Carcinomas have been associated with scarring after infection. Progressive chronic forms are treated with itraconazole for long periods.
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