A male patient, meloderma, a construction worker, 24 years old. He presented himself at the Oral and Maxillofacial Surgery Service complaining about mouth injury, causing dysphagia due to burning and pain. In the anamnesis, there was a clinical course with an evolution of approximately 3 years, with hospitalizations occurring under suspicion of severe tonsillitis with no positive response for treatment.
Physical examination revealed an individual with a symmetrical, normocorate and a febrile face; Absence of regional infracted and painfully lymph nodes. Intraorally, total denture with satisfactory hygiene; presence of a non-bleeding erythro-leucoplastic lesion with irregular surface and diffuse contours that affected the soft palate and oropharynx (Fig. 1).
On the Computerized Tomography (CT) of the face examination, it was possible to observe muco-periosteal thickening of apparently inflammatory origin in the soft palate region with absence of bone involvement in the involved region, with free airways (Fig. 2).
Negative results for HIV, Syphilis (VDRL / FTABS) and Tuberculosis (Escarro T.); without radiographic signs of paracoccidioidomycosis (Paracoccidiodesbrasiliensis) in the thorax. Material was collected for incisional biopsy demonstrating non-specific chronic inflammatory tissue sections with immunohistochemical markings for Paracoccidiodesbrasiliensis (Fig. 3).
The patient was asked to go to the Center for Tropical Diseases of the Evandro Chagas Institute/PA where he was diagnosed with Leishmaniasis by Montenegro intradermoreaction (MIDR). The treatment was started with Fluconazole 400 mg twice a day for one month in combination with Nystatin-based mouth wash three times a day. In 10 days', return there was a slight improvement in the condition.