Imported paracoccidioidomycosis in Spain Fallbericht: Importierte Paracoccidioidomykose Manuel Ginarte, Manuel Pereiro Jr and Jaime Toribio Department of Dermatology, Faculty of Medicine, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain Summary The report deals with three patients, who developed paracoccidioidomycosis in Europe after having been in South America 50, 25 and 38 years before, respectively. The conditions for the long period of quiescent infection and for the late manifestations are discussed. Zusammenfassung Es werden drei Patienten vorgestellt, die in Europa eine Paracoccidioidomykose entwickelten, nachdem sie 50, 25 und 38 Jahre zuvor in Su ¨ damerika gewesen waren. Die Bedingungen fu ¨ r die lange Latenzzeit und die Spa ¨tmanifestation werden diskutiert. Key words: Paracoccidiodes brasiliensis, paracoccidioidomycosis, imported mycosis, Spain. Schlu ¨ sselwo ¨ rter: Paracoccidiodes brasiliensis, Paracoccidioidomykose, importierte Mykose, Spanien. Introduction Paracoccidioidomycosis is a systemic granulomatous mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. It is endemic in rural areas of South America, especially from Brazil, Venezuela, Argentina, and Colombia. Here we report three patients who have presented chronic adult paracoccidioidomycosis while they were living in Europe for 50, 28 and 38 years, respectively, after having come back from South America. One of them has previously been reported. 1 We discuss diag- nostic and therapeutic events. Cases reports Case 1 A 72-year-old male that in 1993 was referred to the Maxillofacial Surgery Service of our hospital for extirpa- tion of a tumoral mass of the upper jaw, following to the clinical diagnosis of squamous cell carcinoma. Forty- eight years ago a stomach ulcer and 10 years ago a polyploid carcinoma of the colon were surgically re- moved. He presented an ulcerated lesion in the upper left jaw, extended to the lip mucosa and the nasal grave (Fig. 1). The lesion was first noted 6 months back and was becoming very painful, affixed to deep planes, infiltrated, and with the dirty bottom. In the routinary presurgical survey, a biopsy specimen was taken from the lesion. Histological examination revealed a chronic gra- nulomatous reaction. Periodic acid–Schiff (PAS) staining revealed PAS-positive elements, suggesting fungal etiol- ogy. The patient was thus referred to our Dermatology Department with the diagnosis of deep mycosis. The patient reported to have lived in Venezuela 50 years ago. Case 2 A 67-year-old man in 1995 presented with a 4-month history of an ulcer located on left cheek mucosa and lower lip. The lesion was very painful and bled easily. On examination, the ulcer was infiltrated and had a necrotic base. Diagnosed as squamous carcinoma, he was provided for surgical extirpation. He reported to have returned from Brazil 28 years ago. One year later he suffered from severe periodontitis with loss of several Correspondence: Dr. Manuel Ginarte, Department of Dermatology, Faculty of Medicine, San Francisco s/n, E-15782 Santiago de Compostela, Spain. Tel.: +34-981-563100 (ext. 12250). Fax: +34-981-547094. E-mail: manuelpe@usc.es Accepted for publication 4 April 2002 Case report Ó 2003 Blackwell Publishing Ltd • Mycoses, 46, 407–411 407