Paracoccidioidomycosis is a severe systemic disease caused by Paracoccidioides brasiliensis (P. brasiliensis). It is a thermal dimorphic fungus, usually acquired through the respiratory tract by inhalation of spores in the air. The infection is insidious and chronic, characterized by the appearance of lesions in the oral and nasal cavities, pharynx, larynx, gums, tongue, soft palate, adrenal glands, liver, bones, gastrointestinal tract, lungs, skin, lymph nodes and nervous system. Dysphonia, dyspnoea, sore throat, dysphagia, weight loss, fever and cough may present as the initial symptoms of the disease. Men over 40, smokers and/or alcohol drinkers are more affected1–3.

In this report, the authors describe three patients with laryngeal paracoccidioidomycosis treated at a public hospital in the Midwest of Brazil.

Diagnosis is based on clinical findings and the identification of P. brasiliensis, present in the pathological exam of the lesions1,2,4. In the cases described, the patients had lesions in the larynx, and were submitted to core biopsy, with a histopathology result suggestive of infection by P. brasiliensis;1,3,5 Lesions found in cases of paracoccidioidomycosis are similar to laryngeal neoplasia, requiring differential diagnosis, and thus the established approach is the histopathological exam4.

Rural workers are at a higher risk because the disease affects mostly individuals whom, by their occupations, are in constant contact with vegetables and earth2,3. Corroborating with the literature, in the reported cases the patients are coming from endemic regions for P. brasiliensis, they are males, smokers and ex-alcoholic and two worked with farming.

Machado Filho et al.3, evaluated 104 individuals diagnosed with the disease. Of these, approximately 40 % had laryngeal lesions, and the vocal cords and epiglottis were the most affected structures.

The literature describes lung nodules as the most common radiological findings2,6. In one of the cases presented, the CT scan showed areas of cavitations with nodules in the lung apex.

In all three cases, the treatment was performed in outpatient clinics with sulfamethoxazole and trimethoprim, due to ease of administration (per os), better compliance and tolerability6. Drug maintenance and regular outpatient follow up were followed as suggested by some authors6.

Paracoccidioidomycosis should be considered in the differential diagnosis of patients with laryngeal lesions, especially those who reside or resided in endemic areas of P. brasiliensis.