Oral paracoccidiodomycosis mimicking lip carcinoma.

A 65-year-old man, actively engaged in farming activities, with a 90 pack-year smoking history, presented with a painless ulcerated lesion on the left labial commissure. He was referred to our department because of suspected neoplasia. The lesion progressed slowly through a 2-year period. Oral examination revealed an extensive ulcer, although flat and with no signs of orbicularis oris muscle infiltration (Fig. 1), involvement of mandibular division of facial nerve, or suspicious neck lymph nodes metastasis. A representative incisional biopsy was performed. Histopathological examination exhibited chronic granulomatous inflammation on conventional hematoxylin–eosin staining. Grocott-Gomori staining showed fungal structures. Clinical and pathological evidences supported the diagnosis of paracoccidioidomycosis (PCM). Itraconazole was maintained for six months with satisfactory response to proposed therapy. PCM is a systemic mycosis characterized by acute or chronic tissue inflammation caused by Paracoccidioides brasiliensis, a pathogenic thermally dimorphic fungus that is endemic to Latin America.1 Active agricultural laborers, masons and civil construction workers, or those who have