Acute Disseminated Paracoccidioidomycosis with Molluscoid Lesions in a Young Woman.

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by a dimorphic fungus. The fungus Paracoccidioides brasiliensis lives in the ground and on plants in tropical and subtropical regions. It is endemic to South America and is the most common of the deep mycoses in Paraguay. Infection occurs by the inhalation of spores during the first decades of life; these spores reach the lungs and can spread to other parts of the body via the blood or lymphatics. The fungus can affect the skin, mucosas, adrenal glands, and other organs.1--4 The 2 main clinical presentations of PCM are the chronic form and the acute/subacute form. The chronic form, which accounts for up to 90% of cases, typically affects male farmers between 30 and 60 years of age. The higher frequency in men is due to the presence of 17-estradiol receptors in the cytoplasm of P. brasiliensis. The interaction between the receptors and the female hormone inhibits transformation of the fungus from the mycelial form to the yeast form; this transformation is essential for infection to develop.3--7 The acute/subacute form (juvenile type) accounts for less than 10% of cases and is mainly observed in young individuals with a depression of cell-mediated immunity. This form has a rapid clinical course (4 to 12 weeks), with alterations of the monocyte-macrophage system and polymorphous skin lesions (nodular, furunculoid, verrucous, ulcer-granulomatous, molluscoid).5,7--9 The gold standard for diagnosis is culture, which must be performed under strict biosafety measures. The fungus grows as mycelia at room temperature and as the yeast in vitro and in tissues at 37◦C.1-5 Other diagnostic methods include serology (immunodiffusion), and molecular studies such as polymerase chain reaction.1,2,10 Histopathology reveals fungal structures, with well or poorly organized granulomas, depending on the immune response.1,7