Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil.

BACKGROUND

Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in Latin America, particularly Brazil, with Paracoccidioides lutzii predominant in Mato Grosso. Ocular involvement is extremely rare (92 cases reported from 1923-2025), often mimicking endemic diseases like cutaneous leishmaniasis.

CASE PRESENTATION: We report the first case of ocular PCM caused by P. lutzii in a 53-year-old male logger from Mato Grosso, Brazil. He presented with right periorbital edema, eyelid ulceration, and nasal lesions initially misdiagnosed as leishmaniasis (positive PCR), treated unsuccessfully with glucantime. Diagnosis was confirmed by fungal culture, direct microscopy (multiple-budding yeasts), and duplex PCR (142 bp amplicon for P. lutzii gp43 exon 2). Chest CT revealed interstitial lesions and adrenal enlargement. Itraconazole (200 mg/day) achieved clinical cure after 12 months, with seroconversion to negative.

LITERATURE REVIEW: A systematic search (LILACS, SciELO, PubMed; 1923-2025) identified 91 prior ocular PCM cases (85 Brazilian), mostly palpebral/conjunctival. This is the first attributed to P. lutzii.

CONCLUSION

Molecular diagnostics are crucial for species identification in atypical PCM presentations, especially in co-endemic areas. Enhanced surveillance, training, and mandatory reporting are needed to reduce misdiagnosis and delays in endemic regions.