Polymorphic Mucocutaneous Lesions on the Face: A Diagnostic Challenge

A 50-year-old, previously healthy male presented with a five-month history of a progressively enlarging erythematous papule on the nose, which evolved into a verrucous plaque on the face. He reported weight loss without fever, arthralgias, or other systemic symptoms. Physical examination revealed confluent verrucous plaques on the face, gingival stomatitis with a moriform appearance, an erythematous plaque on the palate, and bilateral cervical lymphadenopathy. Histopathological exam showed multiple budding yeast cells arranged in a characteristic "mariner's wheel" pattern, consistent with Paracoccidioides spp. The diagnosis of paracoccidioidomycosis was established. This case highlights the importance of including paracoccidioidomycosis in the differential diagnosis of patients with polymorphic mucocutaneous lesions residing in endemic regions.