Paracoccidioidomycosis presenting in the U.K.

Abstract

Conflicts of interest: none declared. Sir, A 51‐year‐old British man presented to the Hospital for Tropical Diseases with a 7‐month history of plantar pruritus and painful cutaneous lesions on his legs, face and feet. The lesions had bled and discharged at times. He had also lost 20 kg in weight and complained of cough and dyspnoea. There was no significant medical history and he was not taking any medications. He smoked 30 cigarettes per day and drank moderate amounts of alcohol. He had worked as an accountant in Maracaibo and Caracas in Venezuela for 20 years and had visited rural areas on business. He returned to the U.K. 2 months after the onset of this illness. On examination, he was afebrile, cachectic but in no acute distress. There were tender erythematous and purpuric macules and exophytic verrucous nodules on the legs and feet bilaterally (Fig. 1a, b). A hyperkeratosis of both plantar regions was noted. The oral cavity was normal but there were small hyperkeratotic nodules adjacent to the commissures. Respiratory examination revealed widespread coarse crackles and wheeze throughout both lung fields. The liver was palpable 4 cm below the right costal margin.