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Made available in DSpace on 2018-11-26T17:34:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-03-01. Added 1 bitstream(s) on 2019-10-09T18:26:46Z : No. of bitstreams: 1 S0037-86822017000200273.pdf: 2372145 bytes, checksum: a77f19b3d3f2cfc9193031dff137b61a (MD5) Clinical presentation of paracoccidioidomycosis (PCM) can be diverse. Morphology and quantity of skin lesions depends on interactions between host immunity and fungus virulence. Diagnosis can be a challenge considering that this fungus has low virulence and some individuals have immunity to microorganism, which results in well-marked granulomas without visible microorganisms. We report herein a clinical presentation of sarcoid-like PCM, initially diagnosed as tuberculoid leprosy. This rare type of PCM is often mistaken for other types of chronic granulomatous diseases. Diagnosis was confirmed after 4 years when a special stain analysis helped in the identification of the specific etiologic agent. Univ Oeste Paulista, Hosp Reg Presidente Prudente, Serv Dermatol, Presidente Prudente, SP, Brazil Univ Estadual Paulista, Fac Med Botucatu, Dept Dermatol & Radioterapia, Botucatu, SP, Brazil Lab Anat Patol & Citopatol, Presidente Prudente, SP, Brazil Univ Nove Julho, Curso Med, Disciplina Dermatol, Sao Paulo, SP, Brazil Univ Estadual Paulista, Fac Med Botucatu, Dept Dermatol & Radioterapia, Botucatu, SP, Brazil

Histiocytoses are rare diseases caused by the proliferation of histiocytes. The pathogenesis remains unknown and the highest incidence occurs in pediatric patients. The clinical presentations can be varied, in multiple organs and systems, and the skin lesions are not always present. Evolution is unpredictable and treatment depends on the extent and severity of the disease. It is described the case of a patient with various neurological symptoms, extensively investigated, who had its was diagnosed with histiocytosis from a single skin lesion. This report highlights the importance of Dermatology in assisting the investigation of difficult cases in medical practice.

A patient with systemic involvement, initially treated as tuberculosis, is presented in this report. There were only two painful subcutaneous nodules, from which we arrived at the correct diagnosis of histoplasmosis. The patient was attended by several experts in the fields of infectious diseases, nephrology and internal medicine, but the diagnosis was only possible after dermatological examination and skin biopsy. This case values multidisciplinary interaction between dermatologists and other medical areas for diagnosis of cases with atypical manifestations.