Photobiomodulation enhances the Th1 immune response of human monocytes.

This study aims to evaluate the effects of photobiomodulation (PBM) on human monocytes, assessing the oxidative burst and ultimate fungicidal potential of these cells, as well as the gene expression at the mRNA level of CD68, CD80, CD163, CD204, IL-6, TNF-α and IL-10 in derived macrophages. Primary cultures of human monocytes were irradiated with an InGaAlP (660 nm)/GaAlAs (780 nm) diode laser (parameters: 40 mW, 0.04 cm2, 1 W/cm2; doses: 200, 400 and 600 J/cm2). Cells were submitted to the chemiluminescence assay, and a microbicidal activity assay against Candida albicans was performed. Reactive oxygen species (ROS) and nitric oxide (NO) production were measured, and cell viability was assessed by the exclusion method using 0.2% Trypan blue reagent. Irradiated monocytes were cultured for 72 h towards differentiation into macrophages. Total RNA was extracted, submitted to reverse transcription and real-time PCR. The results were analysed by ANOVA and the Tukey test (α = 0.05). Irradiated monocytes revealed a significant increase in their intracellular and extracellular ROS (P < 0.001). The 660 nm wavelength and 400 J/cm2 dose were the most relevant parameters (P < 0.001). The fungicidal capacity of the monocytes was shown to be greatly increased after PBM (P < 0.001). PBM increased the expression of TNF-α (P = 0.0302) and the production of NO (P < 0.05) and did not impair monocyte viability. PBM induces a pro-inflammatory Th1-driven response in monocytes and macrophages.

Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis.

OBJECTIVES: To evaluate the effects of photobiomodulation (PBM) in gingival lesions resulting from autoimmune diseases; to compare PBM and topical corticosteroid (CS) treatment; and to assess PBM outcome over time of follow-up. MATERIALS AND METHODS: A comprehensive electronic search was performed in four electronic databases. Treatment effects were measured through visual analog scale of pain (VAS) and clinical evolution of lesion (Thongprasom scale for oral lichen planus (OLP)). Meta-analysis was performed to compare PBM with topical corticosteroid treatment and to evaluate PBM effect over time of follow-up. RESULTS: Seventeen studies were included in this review, of which six were used for the meta-analysis. Meta-analysis results showed no significant differences between PBM and topical CS in pain reduction at baseline (MD = 0.20, 95% CI = - 0.92, 1.32, p = 0.72) and 60-day follow-up (MD = 0.63, 95% CI = - 3.93, 5.19, p = 0.79); however, VAS showed significant pain reduction when compared before and after PBM at 30-day (MD = - 3.52, 95% CI = - 5.40, - 1.64, p = 0.0002) and 60-day (MD = - 5.04, 95% CI = - 5.86, - 4.22, p < 0.00001) follow-up. Thongprasom clinical scale for OLP also showed significant improvement at 30-day follow-up (MD = - 2.50, 95% CI = - 2.92, - 2.08, p < 0.00001) after PBM. CONCLUSION: PBM led to significant reduction of pain and clinical scores of the lesions, not having shown significant differences when compared to topical CS. CLINICAL RELEVANCE: PBM has been used in the treatment of autoimmune gingival lesions, but so far there is little strong evidence to support its use.

Oral Paracoccidioidomycosis affecting women: A systematic review.

Paracoccidioidomycosis (PCM) is an infection caused by fungi of the genus Paracoccidioides and is marked by a strong predilection for men; nevertheless, some women have had developed PCM and have presented oral involvement by the disease. OBJECTIVES: To review all published cases until August 2020 of oral PCM in women, with emphasis on the presence of systemic changes, deleterious habits (tobacco and alcohol) and oral manifestation features through a systematic review. METHODS: Observational studies (both prospective and retrospective) and case reports indexed in the Embase, PubMed, Scopus, Web of Science and LIVIVO databases were selected by two reviewers in a two-phase process following the pre-established PICOS criteria. RESULTS: Twenty-five studies met the eligibility criteria and were selected for qualitative synthesis, of which 72 participants were enrolled. Brazilian White women between 40 and 50 years were the most affected and social history revealed them to be housewives or rural workers. Fifteen women (33.3% of the informed cases) presented any systemic change at the time of PCM diagnosis, namely pregnancy, HIV infection and/or depression. Moriform stomatitis was predominant and affected preferentially the gingivae and alveolar processes in the form of a single painful lesion. Most patients were treated with sulfamethoxazole + trimethoprim or itraconazole. CONCLUSIONS: Oral PCM in women is rare; some cases showed systemic changes at the time of PCM diagnosis, namely HIV infection, pregnancy and depression. New studies should be conducted to elucidate the influence of systemic alterations on the development of oral PCM in women.

Pyogenic granuloma in the tongue of a patient with Down syndrome.

Down syndrome (DS), a genetic disorder caused by chromosome 21 trisomy, is characterized by intellectual disability, congenital malformations, craniofacial alterations, and dentofacial anomalies. Although some oral lesions have been reported in patients with DS, this is the first reported case of a pyogenic granuloma affecting the tongue of a patient with DS. A 20-year-old man presented with a well-demarcated nodular lesion on the right lateral border of the tongue. The 2-cm lesion had a pedunculated base, flaccid consistency, and a superficial ulceration covered by a serofibrinous pseudomembrane. The patient's mother reported that the patient had a recurring habit of traumatizing the lateral border of the tongue. A similar lesion had been surgically removed from the site 1 month earlier, but the excised tissue had not been sent for pathologic analysis. Surgical excision of the new lesion was performed under local anesthesia, and microscopic analysis confirmed the diagnostic hypothesis of pyogenic granuloma, a nonneoplastic vascular hyperplasia of a reactive nature. There was another recurrence at the same site 2 months after the second surgical excision. The patient was given a mandibular silicone mouthguard for 1 month of nightly use to prevent further trauma to the site. Complete healing of the site was observed at the 18-month follow-up examination, and there was no sign of recurrence. Considering the high prevalence of oral alterations in patients with DS, dentists should be able to recognize, diagnose, and correctly manage oral pyogenic granuloma.

Erythema multiforme induced by fluconazole in an immunocompetent patient: a case report and review of the literature.

Erythema multiforme (EM) is an acute hypersensitivity reaction that affects the skin and/or mucosa. EM induced by fluconazole is extremely rare, with only 2 previously published case reports. The aims of this article are to report a rare case of severe EM induced by fluconazole in an immunocompetent patient and to review all similar published cases. A 35-year-old man presented with multiple painful superficial ulcerated lesions on the lips, superficial ulcers on the right and left ocular mucosa, and erythematous macules on the right cervical region. Moreover, multiple painful superficial ulcers covered by a serofibrinous pseudomembrane were located on the oral mucosa. The lesions appeared after the initial oral use of fluconazole (100 mg) 3 weeks previously for the treatment of onychomycosis. The clinical diagnosis was EM associated with fluconazole. The antifungal medication was discontinued, and a single dose of intramuscular Diprospan (5 mg of betamethasone dipropionate/2 mg of betamethasone disodium phosphate) was prescribed. Complete healing of all lesions at the 7-day follow-up was observed.

Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis.

OBJECTIVES: This manuscript presents a systematic review of the clinicopathologic features and outcomes of conservative surgical treatments for nonsyndromic odontogenic keratocysts (OKCs) and assesses the recurrence rates through a meta-analysis, in order to indicate the best conservative approach. MATERIALS AND METHODS: PRISMA guidelines for systematic reviews were followed, and the protocol was registered (PROSPERO/Nr.: CRD42017060964). An electronic search was conducted using the PubMed/MEDLINE, Science Direct, Web of Science, Scopus, and The Cochrane Library databases, and relevant articles were selected based on specific inclusion criteria. The PICOS criteria (Population: nonsyndromic patients of any age with OKC, with histopathological diagnosis and minimum follow-up of 12 months; Intervention and Comparison: marsupialization or decompression with or without enucleation, and enucleation alone; Outcome: recurrence rates; Study design: clinical trials, controlled trials, retrospective studies, and case series containing at least 10 cases of OKC) were employed. A pooled odds ratio (OR) was computed through the Mantel-Haenszel test (M-H) with 95% confidence intervals (CI). RESULTS: One thousand nine hundred OKCs were analyzed; the age of the patients varied from 6 to 90 years (mean of 38.6 years); a male to female ratio of 1.57:1 was observed; 74.5% of the lesions occurred in the mandible; 75.7% of OKCs were unilocular; the association with impacted tooth was reported for 344 OKCs; and the mean follow-up was 60.1 months. One thousand three hundred thirty-one OKCs were treated by conservative surgical treatments, and 261 cases (19.8%) presented recurrence. Nonetheless, minor total recurrence rates were observed after decompression followed by enucleation (11.9%) and marsupialization followed by enucleation (17.8%). In contrast, enucleation alone showed a total recurrence rate of 20.8%. CONCLUSION: The results suggest a significant superiority of success for OKC treatments that use decompression followed by enucleation, instead of an initial enucleation (M-H, OR = 0.48; 95% CI = 0.22 to 1.08; P = 0.0163). CLINICAL RELEVANCE: No consensus exists concerning the best management for OKCs. More aggressive treatments (ostectomy, resection, or use of adjunctive therapies like Carnoy's solution and liquid nitrogen) can have many disadvantages and risks. Therefore, it is necessary to identify the conservative approach for OKCs that results in a lower recurrence rate.

Estrogen Receptor-α Correlates with Higher Fungal Cell Number in Oral Paracoccidioidomycosis in Women.

BACKGROUND: Paracoccidioidomycosis is a neglected tropical fungal infection with great predilection for adult men, indicating the participation of female hormone estrogen in preventing paracoccidioidomycosis development in women. Estrogen has an immunologic effect leading to polarization toward the Th2 immune response, which favors the disease evolution. OBJECTIVES: To evaluate estrogen and progesterone receptors in oral paracoccidioidomycosis lesions and to verify any association with tissue fungi counting in women and men. METHODS: Thirty-two cases of chronic oral paracoccidioidomycosis were included. Immunohistochemical analyses for anti-estrogen receptor-α, anti-progesterone receptor and anti-Paracoccidioides brasiliensis antibodies were performed. The differences between women and men and the relations among the immunomarkers for each gender were also evaluated. RESULTS: A significant positive correlation was observed between estrogen receptor-α and the amount of fungi in women. In addition, estrogen receptor-α was mildly expressed in the inflammatory cells of female patients, while progesterone receptor was expressed in both genders, with similar expression between women and men. Moreover, fungi counting revealed no differences between genders. CONCLUSIONS: Estrogen receptor-α was expressed only in women and showed a positive correlation with the amount of fungi in oral paracoccidioidomycosis, while progesterone receptor was observed in both genders and exhibited no correlation with estrogen receptor-α or fungi counting.

Bell's palsy treated with photobiomodulation in an adolescent: Rare case report and review of the published literature.

BACKGROUND: Bell's palsy represents a peripheral unilateral facial nerve paralysis, being an acute, idiopathic disorder, which can affect children and adolescents. Some therapeutic approaches have been proposed including facial exercises, biofeedback, photobiomodulation, electrotherapy, massage, and thermotherapy. The present report documents a rare case of Bell's palsy in an adolescent successfully treated with a new protocol of photobiomodulation, consisting of a short-term treatment. CASE REPORT: A 13-year-old girl presented absence of facial movement on the right side when smiling, inability to close the right eye and to raise the right eyebrow, intense painful symptoms on the right side of the face, difficult in chewing and talking, and sialorrhea. She was diagnosed with an idiopathic facial paralysis or Bell's palsy associated with right masseter myalgia, and treated with three sessions of photobiomodulation using infrared laser, 100 mW output power, 100 J/cm2 of energy density, 28 seconds per point, applied at the origin and insertion of the right superficial masseter muscle. The patient presented complete regression of paralysis, improvement of speech and chewing, and absence of muscular pain. CONCLUSION: Photobiomodulation was effective to treat Bell's palsy in a pediatric patient, being a true noninvasive approach and with no side effects, although there is still no established definitive protocol.

Fatal primary diffuse large B-cell lymphoma of the maxillary sinus initially treated as an infectious disease in an elderly patient: A clinicopathologic report.

OBJECTIVE: To report a case of primary diffuse large B-cell lymphoma (DLBCL) of the maxillary sinus in an 82-year-old Caucasian woman. BACKGROUND: Diffuse large B-cell lymphoma of the maxillary sinus has non-specific signs and symptoms that may be confused with benign inflammatory conditions and upper respiratory infections. METHODS: An incisional biopsy was performed. CD20+ /CD3- /Ki-67: 95% cells were observed. CONCLUSION: A good medical history, clinical and imaging evaluations and immunohistochemical reactions are crucial to establish a correct and early diagnosis of DLBCL.

Oral Paracoccidioidomycosis Granulomas are Predominantly Populated by CD163+ Multinucleated Giant Cells.

Multinucleated giant cells (MGC) are considered to be a hallmark of granulomatous inflammation; thus, they may play an essential role in the host response against pathogens, particularly Paracoccidioides brasiliensis. This study characterizes the MGC found in oral paracoccidioidomycosis and assesses the correlation of MGC with the amount of fungi within oral tissues. Twenty-six cases were included. They were classified as loose or dense granulomas, and the total MGC, including foreign-body and Langhans giant cells, besides the total and intracellular fungi, were taken into consideration. CD163 immunoexpression was performed, and CD163+ multinucleated giant cells were also quantified. Dense granulomas revealed more foreign-body type and total giant cells than loose granulomas (P < 0.05). Total giant cells showed a positive linear correlation with the CD163+ cells (P = 0.003; r = 0.56) and intracellular fungi quantification (P = 0.045; r = 0.40). Oral paracoccidioidomycosis lesions contain MGC that mainly belong to a CD163+ phenotype, also showing both Langhans and foreign-body arrangements. Additionally, the higher the presence of MGC, the higher the amount of phagocytized fungi.

Extensive Mandibular Ameloblastic Fibro-Odontoma.

Ameloblastic fibro-odontoma (AFO) is a mixed odontogenic tumor that presents epithelial and mesenchymal components. Ameloblastic fibro-odontoma is generally diagnosed between the first and second decades of life and normally shows a slow clinical growth in the posterior portion of the maxilla or mandible, being mostly associated with 1 or more impacted teeth. Radiographic features of AFO show a radiolucent well-defined, uni, or multilocular defect due to containing variable amounts of calcified material. The enucleation of the tumor is the usual conduct and should be followed up for a long period of time. Here, the authors report the case of 17-year-old male patient who presented an extensive AFO on the right posterior side of the mandible. The panoramic radiograph and the tomographic examination revealed a multilocular radiolucent lesion with impacted teeth. Histological examination revealed connective tissue resembling the dental papilla along with epithelial strands or islands, as well as dental hard tissue such enamel and dentin. Enucleation and curettage was performed and led to good outcome. There was no recurrence after an 8-year follow-up, and oral rehabilitation was performed with dental implants.

Giant keratoacanthoma of the lower lip: case report and review of the published literature.

Keratoacanthoma (KA) is an epithelial tumor mainly located on the sun-exposed skin of the face and hands of elderly patients. The giant form of KA affecting the lower lip is relatively rare, and only 2 of 9 recently reported cases were in women. This report describes a case of giant KA of the lower lip in a 62-year-old white woman and discusses clinical and histologic diagnosis and the therapeutic approach to this lesion. The patient reported a 2-month evolution of a nodule characterized by a brownish central plug of keratin and measuring approximately 2.0 cm in its greatest diameter. Keratoacanthoma may present some histopathologic features similar to those of squamous cell carcinoma, and careful attention is required to avoid an incorrect diagnosis. Following histopathologic confirmation of giant KA, complete excision of the lesion was performed. A 17-month follow-up examination revealed complete healing of the area and no signs of recurrence. Because giant KA of the lower lip may impair normal function and esthetics, surgical excision is the best choice for treating this lesion.

Serum antibody levels correlate with oral fungal cell numbers and influence the patients' response to chronic paracoccidioidomycosis.

Paracoccidioidomycosis (PCM) is a neglected fungal disease that elicits an important granulomatous inflammatory reaction which aims to isolate the fungi and resolve the infection; besides the innate cellular response, the patients' sera may contain different levels of antibodies directed against PCM's pathogenic agent: Paracoccidioides brasiliensis (Pb). The aim of the study was to assess the distinct serum antibody levels of 19 chronic PCM patients and to associate these levels to the granulomatous inflammatory response and presence of fungi in oral lesions caused by Pb. The presence of Pb was detected and counted within oral tissues using immunohistochemistry; antibody levels were classified as negative, low-grade, moderate or high-grade groups. The Kruskal-Wallis and Dunn's test were used to verify possible associations among the groups. Interestingly, lower antibody titres were associated with lesser numbers of Pb, which favours the cellular response over the humoral response to fight PCM. On the other hand, negative serological results were linked to a higher presence of Pb in the tissues, indicating that a deficient humoral response supports the fungal proliferation. The number of Pb was conveniently associated with the level of serum antibodies, showing that the humoral immune response is required, however, not solely responsible to restrain the dissemination of Pb.

Resistance to P. brasiliensis Experimental Infection of Inbred Mice Is Associated with an Efficient Neutrophil Mobilization and Activation by Mediators of Inflammation.

Paracoccidioidomycosis (PCM) is a systemic fungal infection, endemic in Brazil, that leads to severe morbidity and even mortality if not correctly treated. Patients may respond differently to PCM depending on the pattern of the acquired immune response developed. The onset of protective immune response is notably mediated by neutrophils (PMN) that play an important role through directly killing the fungi and also by interacting with other cell types to modulate the acquired protective immune response that may follow. In that way, this study aimed to present and compare different experimental models of PCM (intraperitoneal and subcutaneous) regarding PMN production and maturation inside femoral bone marrow and also PMN infiltration in peritoneal and subcutaneous exudates of resistant and susceptible mice. We also assessed the fungal colony forming units and the levels of soluble inflammatory mediators (LTB4, KC, IFN-γ, GM-CSF, and IL-10) inside subcutaneous air-pouches to compare the efficiency of the PMN present at this site in relation to the two main neutrophil functions: initial lysis of the invading pathogen and modulation of the acquired immune response. P. brasiliensis inoculated intraperitoneally was able to disseminate to the bone marrow of susceptible mice, causing a more marked alteration of PMN production and maturation than that observed after resistant mice infection by the same route. Subcutaneous air-pouch inoculation of P. brasiliensis elicited a controlled and limited infection that produced a PMN-rich exudate, thus favoring the study of the interaction between the fungus and the neutrophils. Susceptible mice produced higher numbers of PMN; however, these cells were less effective in killing the fungi. Inflammatory cytokines were more pronounced in resistant mice, which supports their PCM raised resistance.

Cyclin D1 and Ki-67 expression correlates to tumor staging in tongue squamous cell carcinoma.

BACKGROUND: The immunohistochemical expression of Cyclin D1 and Ki-67 were analyzed in tongue squamous cell carcinomas (SCC), relating them to the clinical and morphological exhibition of these tumors. MATERIAL AND METHODS: Twenty-nine patients fulfilled the inclusion criteria; clinical data included gender, age, ethnicity and use of licit drugs such as alcohol and tobacco. The TNM staging and histopathological differentiation grading was assessed for each case. In addition, T1 patients were gathered with T2 patients; and T3 patients were gathered with T4 patients to assemble two distinct groups: (T1/T2) and (T3/T4). RESULTS: The mean follow-up time was 24 months and 30% of the patients died as a consequence of the disease, while 23.3% lived with the disease and 46.7% lived lesion-free. T1 and T2 tumors showed statistically lesser Ki-67 and Cyclin D1 staining when compared to T3 and T4 tumors. CONCLUSIONS: Ki-67 and Cyclin D1 pose as auxiliary tools when determining the progression of tongue SCC at the time of diagnosis.

Rare oral cartilaginous choristoma: a case report and review of the literature.

Cartilaginous choristomas are extraosseous benign tumors. They occur in abnormal sites that usually do not contain chondrocytes. The oral variant of this entity is considered to be very rare, with only 38 cases currently published in the literature. This article presents a case of an oral cartilaginous choristoma lesion. In addition to presenting clinical and histological diagnoses, this article compares the present case to recently reported cases. Special attention was given to analyzing cells of the oral cartilaginous choristoma, which appear as well-differentiated chondrocytes with a pale blue cytoplasm surrounded by a light basophilic stroma and no evidence of malignity. Following surgical excision, the lesion did not recur, which is similar to other reported cases of oral cartilaginous choristomas.

Noninvasive treatment choice for an aged down syndrome patient presenting a residual periapical cyst.

AIM: This is the first report to illustrate the marsupialization as an effective treatment for a Down Syndrome (DS) patient presenting a residual periapical cyst. BACKGROUND: These cysts occur within the alveolar ridge, usually at the local site of a previously extracted tooth that did not received proper curettage; usually the surgical excision of a cyst and also the vigorous curettage of a socket is very simple, if not for the fact that mentally disabled patients require rapid and non-stressful procedures. CASE DESCRIPTION: The 54-year-old DS patient represented herein received a minimally invasive marsupialization under local anesthesia. Due to the large extent of the lesion, the acrylic resin drain was maintained for 30 days. Through the following period, a daily irrigation of the cystic cavity with saline solution was carried out to prevent a secondary infection within the cystic cavity. A follow-up of 16 months showed no signs of recurrence. CONCLUSION: Marsupialization of residual periapical cyst is completely effective and safe, even for a DS patient that is considered to be at an advanced age. CLINICAL SIGNIFICANCE: Marsupialization poses as a minimally invasive choice for mentally disabled patients, even when presenting advanced ages; treatment success was stated by the easy clinical conduct, uneventful postoperative situation and the lack of recurrence along 16 months of follow-up.

Effects of celecoxib treatment over the AKT pathway in head and neck squamous cell carcinoma.

BACKGROUND: Celecoxib, a non-steroidal anti-inflammatory drug that selectively inhibits cyclooxygenase-2 (COX-2), has shown an important anticarcinogenic effect for the treatment of squamous cell carcinoma. The use of COX-2 inhibitors has effectively inhibited the growth of Head and Neck Squamous Cell Carcinoma (HNSCC) cell lines, while a recent phase 1 trial demonstrated good response rate of cancer cells to this drug with minimal toxicity. Possible targets of celecoxib include proteins involved in cell proliferation and apoptosis control. Additionally, celecoxib antitumoral activity has been linked with a COX-2-independent event. METHODS: To better understand which cellular mechanisms are targeted by celecoxib, its effects upon the Akt signaling pathway using two different HNSCC cell lines were analyzed through cell viability assay, immunofluorescence, and Western blotting. RESULTS: The results showed decreased levels of Cyclin D1 and pAkt protein expression in vitro. The number of viable cells was also diminished after celecoxib treatment. CONCLUSION: As Akt pathway seems to be a valuable target for the HNSCC therapy, the results presented herein confirm that celecoxib can be considered as an alternative adjuvant drug for HNSCC treatment.

Impact of the COVID-19 pandemic on head and neck cancer patients: systematic review and meta-analysis.

OBJECTIVES: This manuscript presents a systematic review of the impact of the COVID-19 pandemic on head and neck cancer (HNC) patients. A meta-analysis was made to compare the number of treated/operated HNC patients in the pre-COVID-19 era versus the COVID-19 era. This investigation was based on previous reports showing a delay in the diagnosis and treatment of new cases of cancer during the pandemic. Worsening in cancer prognosis would be expected as a result of the delayed treatments. METHOD AND MATERIALS: An electronic search was conducted using the PubMed/MEDLINE, Embase, Web of Science, Scopus, and The Cochrane Library databases. Relevant articles were selected based on specific inclusion criteria. RESULTS: A total of 8,942 HNC patients were included. A higher prevalence in male (1,873) in comparison to female (1,695) was observed considering 3,568 patients. Regarding staging, the majority of cases were stage III to IV. The treatment type more frequently described was surgery. Positive diagnosis for COVID-19 in the pre-oncologic treatment was reported for 242 patients, and for post-oncologic treatment in 119 patients. Mortality by COVID-19 was reported for 27 HNC patients. The meta-analysis revealed a significantly smaller number of surgeries/oncologic treatments of HNC patients performed (2,666) in the COVID-19 era when compared to the pre-COVID-19 era (3,163) (Mantel-Haenszel odds ratio = 0.81, 95% CI = 0.65 to 1.00, P = .05). CONCLUSION: The impact of the COVID-19 pandemic on HNC patients occurred mainly in the number of surgeries/oncologic treatments, showing a significantly smaller number of surgeries/oncologic treatments performed in the COVID-19 era rather than the pre-COVID-19 era.

Difficulty in diagnosing oral paracoccidioidomycosis after topical nystatin usage.

Paracoccidioidomycosis (PCM) is caused by a dimorphic fungus called Paracoccidioides brasiliensis and is a disseminated, systemic disorder that involves the lungs and other organs but presents characteristic oral lesions as the prominent feature. This article reports an unusual case of a 56-year-old man who had symptomatic granulomatous lesions in the oral cavity. The patient had received a nystatin-based treatment that masked the presence of fungi and made the diagnosis of PCM difficult. Although nystatin is normally used to treat oral fungal infections such as candidiasis, its topical usage is not appropriate for management of PCM. Once the patient received the correct treatment, he demonstrated a full recovery.