Brazilian Journal of Case Reports 2023, 3, 1, 16-21. https://doi.org/10.52600/2763-583X.bjcr.2023.3.1.16-21 www.bjcasereports.com.br Case Report Paracoccidioidomycosis differential diagnosis: case series Ezequias Batista Martins 1 , Natalia Chilinque Zambão da Silva 1 , Laura da Cunha Ferreira 1 , Karla Regina Oliveira de Moura Ronchini 1 , Daniel Abner Paiva Caetano 2 , Remberto Mauricio de La Cruz Vargas Vilte 1 , Ianick Souto Martins 1 , Anielle de Pina Costa 3 , Billy McBenedict 1 , Juliana Arcenio Alves dos Santos 1 , Carolina Romero Ma- chado 2 , Danyelle Cristina de Souza 2 , Thais de Oliveira Vieira 2 , Patrícia Yvonne Maciel Pinheiro 2 1 Universidade Federal Fluminense, Faculdade de Medicina, Niterói, Rio de Janeiro, Brazil. 2 Hospital Universitário Antônio Pedro, Serviço de Infectologia, Niterói, Rio de Janeiro, Brazil. 3 Universidade Federal Fluminense, Faculdade de Enfermagem, Niterói, Rio de Janeiro, Brazil. * Correspondence: ezequiasm@id.uff.br. Abstract: Paracoccidioidomycosis is a neglected disease and the most important systemic mycosis in Latin America. This fungal infection is directly linked to activities related to the rural environ- ment, such as agriculture. Despite being a frequently diagnosed disease in Brazil, the real rates of prevalence and incidence are not estimated due to the non-mandatory notification of the disease, which was recently implemented in 2020. We report three interesting cases of Paracoccidioidomy- cosis in immunocompetent adults, with varied clinical manifestations. Keywords: Paracoccidioides sp.; Paracoccidioidomycosis; Systemic mycosis; Diagnosis; Brazil. 1. Introduction Paracoccidioidomycosis (PCM) is a systemic mycosis restricted to Latin America and occurs mainly in tropical areas of Brazil, Argentina, Colombia, Ecuador, and Vene- zuela [1]. This disease is more prevalent in adult men who perform agricultural activities. Currently, there is an increasing number of cases in urban areas with a greater represen- tation in females [2]. The etiological agents are classifield in the Paracoccidioides brasiliensis complex [3]. Infection can produce acute disease, or the fungus can remain dormant and manifest itself after a few years. The chronic disease manifests by pulmonary involvement and the pres- ence of ulcerated lesions on the skin and mucousa [4-6]. Definitive diagnosis of PCM is obtained by direct observation or culture of the fungus [1]. The Itraconazole (200 mg daily for 9-12 months) is the best treatment option for mild to moderate clinical forms of the disease and Cotrimoxazole (trimethoprim-sulfamethoxazole) for 18-24 months is the main therapeutic alternative to Itraconazole. A short (2–4 weeks) induction therapy with Amphotericin B (AmB) is reserved for severe cases of the disease [7]. In this study we describe a series of patients diagnosed with PCM in an endemic area of in Brazil. 2. Case Report 2.1 Case 1 In July 2021, a 19-year-old healthy black female ballet dancer presented with cervical and inguinal lymph node enlargement associated with asthenia, low-grade fever, and progressive weight loss. The computed tomography (CT) scan indicated the presence of fluid in the pelvic cavity, and inguinal lymphadenopathy. In May 2022, the diagnosis of the patient was not yet confirmed. In this period, vesicular and crusted lesions appeared Citation: Martins EB, Silva NCZ, Ferreira LC, Ronchini KROM, Cae- tano DAP, Vilte RMLCV, Martins IA, Costa AP, McBenedict B, Santos JAA, Machado CR, Souza DC, Vieira TO, Pinheiro PYM. Paracoccidioidomy- cosis differential diagnosis: case se- ries. Brazilian Journal of Case Re- ports. 2023 Jan-Mar;03(1):16-21. Received: 13 January 2023 Accepted: 2 February 2023 Published: 04 February 2023 Copyright: This work is licensed un- der a Creative Commons Attribution 4.0 International License (CC BY 4.0).