PMID- 11454087
OWN - NLM
STAT- MEDLINE
DCOM- 20010809
LR  - 20190722
IS  - 0011-9059 (Print)
IS  - 0011-9059 (Linking)
VI  - 40
IP  - 4
DP  - 2001 Apr
TI  - Hard palate perforation: an unusual finding in paracoccidioidomycosis.
PG  - 281-3
AB  - A 36-year-old black man presented to his dermatologist in May 1996 complaining of 
      mucosal lesions in the mouth, as well as perforation of the hard palate. The 
      lesions had started approximately 7 months before and had worsened gradually. 
      Other complaints included odynophagia, dysphagia, mild dyspnea, and dry cough. 
      The patient was in good general health, but reported a 3 kg weight loss over the 
      previous semester. The hard and soft palate presented erythematous ulcers with a 
      finely granulated base and irregular, but clearly defined margins. A perforation 
      (diameter, 0.5 cm) of the hard palate was seen in the center of the ulcerated 
      region (Fig. 1). Direct examination of 10% KOH cleared specimens showed typical 
      double-walled, multiple budding yeast structures. Paracoccidioidomycosis (PCM) 
      serologic reactions tested positive for double immunodiffusion (DI), complement 
      fixation (CF) 1 : 256 and counterimmunoelectrophoresis (CIE) 1 : 128. Hematoxylin 
      and eosin-stained sections of oral lesions showed an ulcer covered by a fibrous 
      leukocytic crust, with a lymphoplasmacytic infiltrate, as well as multinuclear 
      giant cells containing round bodies with a double membrane. Gomori-Grocott 
      staining showed budding and blastoconidia suggestive of PCM. Lung computed 
      tomography (CT) exhibited findings consistent with pulmonary PCM. Diagnosis of 
      the chronic multifocal form of PCM with oral and pulmonary manifestations was 
      established. Drug therapy was initiated with ketoconazole (KCZ) 200 mg twice 
      daily, which led to clinical cure in approximately 2 months. Serum antibody 
      values rose 30 days after institution of therapy (CIE 1 : 256; CF 1 : 512), 
      peaking at day 60 (CIE 1 : 1024; CF 1 : 1024). Three months later the daily dose 
      was reduced to 200 mg and titers declined slowly. The diameter of the perforation 
      remained unchanged (Fig. 2). The hard palate perforation was corrected with a 
      palatoplasty 27 months after initiation of drug therapy (Fig. 3). KCZ was 
      discontinued when serologic cure was achieved after 34 months of treatment (DI 
      weakly positive; CIE 1 : 8; CF not measurable). The patient was discharged 46 
      months after the first visit.
FAU - Castro, L G
AU  - Castro LG
AD  - Division of Dermatology, Hospital das Clinicas, Schools of Medicine and 
      Dentistry, University of Sao Paulo, R. Mato Grosso 128 cj 34, Sao Paulo/SP, 
      01239-040 Brazil. guiga@dermamail.com.br
FAU - Muller, A P
AU  - Muller AP
FAU - Mimura, M A
AU  - Mimura MA
FAU - Migliari, D A
AU  - Migliari DA
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Int J Dermatol
JT  - International journal of dermatology
JID - 0243704
RN  - 0 (Antifungal Agents)
RN  - R9400W927I (Ketoconazole)
SB  - IM
MH  - Adult
MH  - Antifungal Agents/therapeutic use
MH  - Humans
MH  - Ketoconazole/therapeutic use
MH  - Male
MH  - Oral Surgical Procedures
MH  - Palate, Hard/microbiology/*pathology/surgery
MH  - Paracoccidioidomycosis/drug therapy/*microbiology
MH  - Saccharomycetales/drug effects
EDAT- 2001/07/17 10:00
MHDA- 2001/08/10 10:01
CRDT- 2001/07/17 10:00
PHST- 2001/07/17 10:00 [pubmed]
PHST- 2001/08/10 10:01 [medline]
PHST- 2001/07/17 10:00 [entrez]
AID - ijd1212 [pii]
AID - 10.1046/j.1365-4362.2001.01212.x [doi]
PST - ppublish
SO  - Int J Dermatol. 2001 Apr;40(4):281-3. doi: 10.1046/j.1365-4362.2001.01212.x.