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Abstract
Figure 1. Cervical lymph node enlargement. Figure 2. Nasal mucosa lesion. A 43 year-old man, farmer, born in Santo Antonio do Norte, Minas Gerais, Brazil, developed Paracoccidioidomycosis (PCM) in 1983, when he was eighteen. He presented cervical, submandibular, supraclavicular, axillary and inguinal lymph node enlargement, and also involvement of the oral mucosa, lungs and guts. The diagnosis was made through the finding of Paracoccidioides brasiliensis in lymph node secretion and phlegm. He was admitted to the Hospital das Clinicas of the Universidade Federal de Minas Gerais and treated with Sulfadiazine, Sulfamethoxazole/ Trimethoprim and Ketoconazole for two months. After discharged from hospital he had no ambulatorial follow up or took any medicine. He revealed moderate tabagism and alcohol intake. In 1991 moved out to the metropolitan area of Belo Horizonte and became a doorman. He had no contact with any endemic area of PCM ever since. In 2004 he quitted tobacco smoking and alcohol drinking. In January of 2008 he started loosing weight and showed dysphonia, odynophagia, vomiting, abdominal pain, low gastrointestinal hemorrhage, dyspnea, cough with expectoration and enlargement of cervical (Figure 1), axillary, navel and inguinal lymph node with suppuration. He also exhibited plaques and papules on the face and neck; ulcerated-vegetative lesions in the
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