Fig.13-A1
Paracoccidioidomycosis

A 70-years old coffee farmer from the Venezuelan Andes suffered a stomatitis for several months. He lost weight in the last weeks, had fever, a nasty cough, and loss of appetite. At the inside of the lips a flat ulcer was seen surrounded by a diffusely reddened and swollen mucosa. The patient died 6 days after being hospitalized. Fungi were found in smears from the oral mucosa and in the markedly enlarged suprarenals.

Fig.13-A2
Paracoccidioidomycosis

Both suprarenals were enlarged and revealed caseification. The involvement of suprarenals is found especially in the final stages of evolution in the paracoccidioidomycosis and histoplasmosis.

Fig.13-A3
Paracoccidioidomycosis

The diffuse necrotic caseification of the suprarenal is shown here in the HE stain and at a low power magnification.

Fig.13-A4
Paracoccidioidomycosis

With the Grocott stain numerous large, round yeast cells are seen which are partly deformed and end showing a veakly blackish color. The multiple budding allows the histological diagnosis of the infection with Paracoccidioides brasiliensis.