<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932026000100315</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2026.e13142615</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Úlcera perianal como manifestación de paracoccidioidomicosis sistémica]]></article-title>
<article-title xml:lang="en"><![CDATA[Perianal ulcer as a manifestation of systemic paracoccidioidomycosis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torres Franco]]></surname>
<given-names><![CDATA[Camila Luján]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramos Alfonzo]]></surname>
<given-names><![CDATA[Alejandra Noemí]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Central Instituto de Previsión Social  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>13</volume>
<numero>1</numero>
<fpage>315</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932026000100315&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932026000100315&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932026000100315&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La paracoccidioidomicosis (PCM) es una micosis sistémica endémica de América Latina, causada por hongos termo-dimórficos del género Paracoccidioides, que afecta predominantemente a varones adultos con antecedentes de exposición a áreas rurales. Sus manifestaciones clínicas son variables y dependen de la forma de presentación y de la diseminación del agente, siendo infrecuente el compromiso anorrectal. Se presenta el caso de un paciente masculino de 54 años, que consultó por una úlcera perianal crónica dolorosa de un año de evolución, asociada a pérdida de peso significativa y síntomas respiratorios progresivos. Los estudios complementarios evidenciaron compromiso pulmonar cavitario, lesiones laríngeas, afectación intestinal y compromiso neurológico. El estudio microbiológico y anatomopatológico de la lesión perianal confirmaron el diagnóstico de PCM sistémica. Durante la evolución, el paciente presentó complicaciones asociadas al tratamiento antifúngico, incluyendo injuria renal aguda y encefalitis infecciosa, lo que motivó múltiples ajustes terapéuticos hasta lograr mejoría clínica con voriconazol. Este caso resalta la importancia de considerar la PCM dentro del diagnóstico diferencial de úlceras perianales crónicas en pacientes provenientes de áreas endémicas, así como la necesidad de un enfoque terapéutico individualizado y multidisciplinario ante presentaciones clínicas atípicas y evolución compleja.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America, caused by thermo-dimorphic fungi of the genus Paracoccidioides, which predominantly affects adult males with a history of exposure to rural areas. Its clinical manifestations are variable and depend on the form of presentation and dissemination of the agent, with anorectal involvement being uncommon. We present the case of a 54-year-old male patient who consulted for a chronic painful perianal ulcer of one year's evolution, associated with significant weight loss and progressive respiratory symptoms. Complementary studies revealed cavitary pulmonary involvement, laryngeal lesions, intestinal involvement, and neurological involvement. Microbiological and anatomopathological studies of the perianal lesion confirmed the diagnosis of systemic PCM. During the course of the disease, the patient developed complications associated with antifungal treatment, including acute renal injury and infectious encephalitis, which led to multiple therapeutic adjustments until clinical improvement was achieved with voriconazole. This case highlights the importance of considering PCM in the differential diagnosis of chronic perianal ulcers in patients from endemic areas, as well as the need for an individualized and multidisciplinary therapeutic approach in the face of atypical clinical presentations and complex evolution.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[paracoccidioidomicosis]]></kwd>
<kwd lng="es"><![CDATA[úlcera]]></kwd>
<kwd lng="es"><![CDATA[enfermedades del ano]]></kwd>
<kwd lng="es"><![CDATA[infecciones fúngicas invasoras]]></kwd>
<kwd lng="es"><![CDATA[enfermedades endémicas]]></kwd>
<kwd lng="en"><![CDATA[paracoccidioidomycosis]]></kwd>
<kwd lng="en"><![CDATA[ulcer]]></kwd>
<kwd lng="en"><![CDATA[diseases of the anus]]></kwd>
<kwd lng="en"><![CDATA[invasive fungal infections]]></kwd>
<kwd lng="en"><![CDATA[endemic diseases]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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