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diagnostic challenge in an individual with Paracoccidioidomycosis during hospitalization in times of COVID-19

Paracoccidioidomycosis (PCM) is a deep fungal infection, endemic with considerable morbidity in South America, whose first symptoms can occur in the oral cavity. A 47-year-old male patient, leucoderma, living on the streets, presenting dyspnea, pain during the speech, and dysphagia, was referred for admission to the ICU for suspected COVID-19 infection. The intensive care physician's evaluation revealed a tongue lesion with suspected carcinoma. By dentist investigation, was observed the presence of moriform lesions with high borders delimitation in the tongue. Also, granulomatous ulcers with irregular texture, suggesting moriform stomatitis, the chest tomography revealed diffuse thickening of the bronchial walls, indicating chronic bronchopathy with discrete centrilobular nodules, sometimes confluent. Incisional tongue biopsy associated with lung imaging confirmed the diagnosis of PCM, and the patient was referred to the referral center for the treatment of fungal diseases. The involvement of the oral environment as a region to the appearance of detectable first symptoms of PCM suggests the need for the oral evaluation by a specialist as a diagnostic tool.