Paracoccidioidomycosis in pregnancy: an atypical case report.

A 38-year-old woman was referred to the department of Oral Pathology at the Universidade Paulista, Goiânia, Brazil, complaining of multiple painful ulcers on the gum and upper lip mucosa. The patient was six month pregnant and had regularly attended prenatal visits. The patient had a history of weight loss due to inability to swallow solid foods in the last two months. Also, the patient complained of drooling. Her pulse and blood pressure were normal. Clinical examination revealed palpable lymph nodes in the submandibular region. The facial muscles were normal and showed no visible asymmetry. The intra oral examination showed the presence of multiple painful moriform ulcers in the upper gum, palate and upper lip. The lesion on her lip was similar to a granulomatous cheilitis (Fig. 1). The gum lesions were mulberry-like, with distinctly visible hemorrhagic pinpoints on the surface (Fig. 2). The teeth involved had severe degrees of mobility, such as in periodontal disease. Incisional biopsy was performed in the gum, where the histological sections revealed the presence of granulomatous inflammation, with pseudoepitheliomatous hyperplasia, with the presence of macrophages, epithelioid cells, multinucleated giant cells, histiocytes, as well as lymphocytes (Fig. 3).