Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil

Nathan Pereira Lopes de Siqueira; Vitoria Lucchesi Ribeiro; Giovana Volpato Pazin; Henrique Soares de Lima; Ana Paula Possa; Breno Pinheiro; Anderson Messias Rodrigues; Zoilo Pires de Camargo; Ferry Hagen; Marcia Hueb; André Mozena; Rafaela Dotta Brustolin de Mendonça; Andreia Ferreira Nery; Rosane Christine Hahn

doi:10.1016/j.diagmicrobio.2026.117563

Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil

Nathan Pereira Lopes de Siqueira^*
, Vitoria Lucchesi Ribeiro
, Giovana Volpato Pazin
, Henrique Soares de Lima
, Ana Paula Possa
, Breno Pinheiro
, Anderson Messias Rodrigues
, Zoilo Pires de Camargo
, Ferry Hagen
, Marcia Hueb
, André Mozena
, Rafaela Dotta Brustolin de Mendonça
, Andreia Ferreira Nery
, Rosane Christine Hahn

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in Latin America, particularly Brazil, with Paracoccidioides lutzii predominant in Mato Grosso. Ocular involvement is extremely rare (92 cases reported from 1923-2025), often mimicking endemic diseases like cutaneous leishmaniasis.

CASE PRESENTATION: We report the first case of ocular PCM caused by P. lutzii in a 53-year-old male logger from Mato Grosso, Brazil. He presented with right periorbital edema, eyelid ulceration, and nasal lesions initially misdiagnosed as leishmaniasis (positive PCR), treated unsuccessfully with glucantime. Diagnosis was confirmed by fungal culture, direct microscopy (multiple-budding yeasts), and duplex PCR (142 bp amplicon for P. lutzii gp43 exon 2). Chest CT revealed interstitial lesions and adrenal enlargement. Itraconazole (200 mg/day) achieved clinical cure after 12 months, with seroconversion to negative.

LITERATURE REVIEW: A systematic search (LILACS, SciELO, PubMed; 1923-2025) identified 91 prior ocular PCM cases (85 Brazilian), mostly palpebral/conjunctival. This is the first attributed to P. lutzii.

CONCLUSION: Molecular diagnostics are crucial for species identification in atypical PCM presentations, especially in co-endemic areas. Enhanced surveillance, training, and mandatory reporting are needed to reduce misdiagnosis and delays in endemic regions.

Original language	English
Article number	117563
Journal	Diagnostic Microbiology and Infectious Disease
Volume	116
Issue number	4
Early online date	17 Jul 2026
DOIs	https://doi.org/10.1016/j.diagmicrobio.2026.117563
Publication status	E-pub ahead of print - 17 Jul 2026

Keywords

Differential diagnosis
Endemic areas
Molecular methods
Ocular paracoccidioidomycosis
Paracoccidioides lutzii

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de Siqueira, N. P. L., Ribeiro, V. L., Pazin, G. V., de Lima, H. S., Possa, A. P., Pinheiro, B., Rodrigues, A. M., de Camargo, Z. P., Hagen, F., Hueb, M., Mozena, A., de Mendonça, R. D. B., Nery, A. F., & Hahn, R. C. (2026). Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil. Diagnostic Microbiology and Infectious Disease, 116(4), Article 117563. Advance online publication. https://doi.org/10.1016/j.diagmicrobio.2026.117563

@article{9d970d0a1daf4f74a77921daeb541c58,

title = "Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil",

abstract = "BACKGROUND: Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in Latin America, particularly Brazil, with Paracoccidioides lutzii predominant in Mato Grosso. Ocular involvement is extremely rare (92 cases reported from 1923-2025), often mimicking endemic diseases like cutaneous leishmaniasis.CASE PRESENTATION: We report the first case of ocular PCM caused by P. lutzii in a 53-year-old male logger from Mato Grosso, Brazil. He presented with right periorbital edema, eyelid ulceration, and nasal lesions initially misdiagnosed as leishmaniasis (positive PCR), treated unsuccessfully with glucantime. Diagnosis was confirmed by fungal culture, direct microscopy (multiple-budding yeasts), and duplex PCR (142 bp amplicon for P. lutzii gp43 exon 2). Chest CT revealed interstitial lesions and adrenal enlargement. Itraconazole (200 mg/day) achieved clinical cure after 12 months, with seroconversion to negative.LITERATURE REVIEW: A systematic search (LILACS, SciELO, PubMed; 1923-2025) identified 91 prior ocular PCM cases (85 Brazilian), mostly palpebral/conjunctival. This is the first attributed to P. lutzii.CONCLUSION: Molecular diagnostics are crucial for species identification in atypical PCM presentations, especially in co-endemic areas. Enhanced surveillance, training, and mandatory reporting are needed to reduce misdiagnosis and delays in endemic regions.",

keywords = "Differential diagnosis, Endemic areas, Molecular methods, Ocular paracoccidioidomycosis, Paracoccidioides lutzii",

author = "\{de Siqueira\}, \{Nathan Pereira Lopes\} and Ribeiro, \{Vitoria Lucchesi\} and Pazin, \{Giovana Volpato\} and \{de Lima\}, \{Henrique Soares\} and Possa, \{Ana Paula\} and Breno Pinheiro and Rodrigues, \{Anderson Messias\} and \{de Camargo\}, \{Zoilo Pires\} and Ferry Hagen and Marcia Hueb and Andr{\'e} Mozena and \{de Mendon{\c c}a\}, \{Rafaela Dotta Brustolin\} and Nery, \{Andreia Ferreira\} and Hahn, \{Rosane Christine\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = jul,

day = "17",

doi = "10.1016/j.diagmicrobio.2026.117563",

language = "English",

volume = "116",

journal = "Diagnostic Microbiology and Infectious Disease",

issn = "0732-8893",

publisher = "Elsevier",

number = "4",

}

de Siqueira, NPL, Ribeiro, VL, Pazin, GV, de Lima, HS, Possa, AP, Pinheiro, B, Rodrigues, AM, de Camargo, ZP, Hagen, F, Hueb, M, Mozena, A, de Mendonça, RDB, Nery, AF & Hahn, RC 2026, 'Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil', Diagnostic Microbiology and Infectious Disease, vol. 116, no. 4, 117563. https://doi.org/10.1016/j.diagmicrobio.2026.117563

Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil. / de Siqueira, Nathan Pereira Lopes; Ribeiro, Vitoria Lucchesi; Pazin, Giovana Volpato et al.
In: Diagnostic Microbiology and Infectious Disease, Vol. 116, No. 4, 117563, 12.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Historical series of paracoccidioidomycosis ocular cases (1923-2025)

T2 - emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil

AU - de Siqueira, Nathan Pereira Lopes

AU - Ribeiro, Vitoria Lucchesi

AU - Pazin, Giovana Volpato

AU - de Lima, Henrique Soares

AU - Possa, Ana Paula

AU - Pinheiro, Breno

AU - Rodrigues, Anderson Messias

AU - de Camargo, Zoilo Pires

AU - Hagen, Ferry

AU - Hueb, Marcia

AU - Mozena, André

AU - de Mendonça, Rafaela Dotta Brustolin

AU - Nery, Andreia Ferreira

AU - Hahn, Rosane Christine

PY - 2026/7/17

Y1 - 2026/7/17

N2 - BACKGROUND: Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in Latin America, particularly Brazil, with Paracoccidioides lutzii predominant in Mato Grosso. Ocular involvement is extremely rare (92 cases reported from 1923-2025), often mimicking endemic diseases like cutaneous leishmaniasis.CASE PRESENTATION: We report the first case of ocular PCM caused by P. lutzii in a 53-year-old male logger from Mato Grosso, Brazil. He presented with right periorbital edema, eyelid ulceration, and nasal lesions initially misdiagnosed as leishmaniasis (positive PCR), treated unsuccessfully with glucantime. Diagnosis was confirmed by fungal culture, direct microscopy (multiple-budding yeasts), and duplex PCR (142 bp amplicon for P. lutzii gp43 exon 2). Chest CT revealed interstitial lesions and adrenal enlargement. Itraconazole (200 mg/day) achieved clinical cure after 12 months, with seroconversion to negative.LITERATURE REVIEW: A systematic search (LILACS, SciELO, PubMed; 1923-2025) identified 91 prior ocular PCM cases (85 Brazilian), mostly palpebral/conjunctival. This is the first attributed to P. lutzii.CONCLUSION: Molecular diagnostics are crucial for species identification in atypical PCM presentations, especially in co-endemic areas. Enhanced surveillance, training, and mandatory reporting are needed to reduce misdiagnosis and delays in endemic regions.

AB - BACKGROUND: Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in Latin America, particularly Brazil, with Paracoccidioides lutzii predominant in Mato Grosso. Ocular involvement is extremely rare (92 cases reported from 1923-2025), often mimicking endemic diseases like cutaneous leishmaniasis.CASE PRESENTATION: We report the first case of ocular PCM caused by P. lutzii in a 53-year-old male logger from Mato Grosso, Brazil. He presented with right periorbital edema, eyelid ulceration, and nasal lesions initially misdiagnosed as leishmaniasis (positive PCR), treated unsuccessfully with glucantime. Diagnosis was confirmed by fungal culture, direct microscopy (multiple-budding yeasts), and duplex PCR (142 bp amplicon for P. lutzii gp43 exon 2). Chest CT revealed interstitial lesions and adrenal enlargement. Itraconazole (200 mg/day) achieved clinical cure after 12 months, with seroconversion to negative.LITERATURE REVIEW: A systematic search (LILACS, SciELO, PubMed; 1923-2025) identified 91 prior ocular PCM cases (85 Brazilian), mostly palpebral/conjunctival. This is the first attributed to P. lutzii.CONCLUSION: Molecular diagnostics are crucial for species identification in atypical PCM presentations, especially in co-endemic areas. Enhanced surveillance, training, and mandatory reporting are needed to reduce misdiagnosis and delays in endemic regions.

KW - Differential diagnosis

KW - Endemic areas

KW - Molecular methods

KW - Ocular paracoccidioidomycosis

KW - Paracoccidioides lutzii

UR - https://www.scopus.com/pages/publications/105047420040

U2 - 10.1016/j.diagmicrobio.2026.117563

DO - 10.1016/j.diagmicrobio.2026.117563

M3 - Article

C2 - 42600206

SN - 0732-8893

VL - 116

JO - Diagnostic Microbiology and Infectious Disease

JF - Diagnostic Microbiology and Infectious Disease

IS - 4

M1 - 117563

ER -

Historical series of paracoccidioidomycosis ocular cases (1923-2025): emphasis on molecular diagnosis of P. lutzii in Midwestern Brazil

Abstract

Keywords

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