{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T15:45:33Z","timestamp":1780587933044,"version":"3.54.1"},"reference-count":94,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paracoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America, classically characterized by pulmonary, mucosal and lymphatic involvement. Extrapulmonary manifestations affecting uncommon organs remain poorly characterized and may contribute to diagnostic delay and adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective case series of proven or probable atypical extrapulmonary PCM diagnosed at a Brazilian tertiary referral center between 2006 and 2025. A systematic review registered in PROSPERO and conducted according to PRISMA recommendations identified osteoarticular, bone marrow and urogenital PCM cases between 1970 to November 2025 in PubMed\/MEDLINE and Embase without language restrictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 205\n                      <jats:styled-content style=\"fixed-case\">PCM<\/jats:styled-content>\n                      patients evaluated at our institution, 14 (6.8%) presented atypical extrapulmonary involvement. Combined with 153 cases identified in 75 studies, 167 cases were analysed. Osteoarticular involvement was the most frequent manifestation (53.9%), predominantly affecting young patients with acute\/subacute disease and presenting mainly as osteomyelitis with lytic lesions. Bone marrow involvement occurred exclusively in acute\/subacute\n                      <jats:styled-content style=\"fixed-case\">PCM<\/jats:styled-content>\n                      and was associated with post\u2010mortem diagnosis (9.7%) and markedly elevated mortality (77.8%). Urogenital\n                      <jats:styled-content style=\"fixed-case\">PCM<\/jats:styled-content>\n                      mainly affected middle\u2010aged men with chronic disease, frequently involving the testicles and prostate, and was associated with delayed diagnosis, surgical intervention (32.7%), and mortality (32.0%). Distinct epidemiological profiles, clinical forms and outcomes were consistently observed across atypical sites.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Atypical extrapulmonary PCM manifestations follow recognizable clinical patterns associated with diagnostic delay and poor outcomes, supporting earlier investigation and timely antifungal therapy in endemic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/myc.70182","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:30:23Z","timestamp":1777368623000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Patterns of Osteoarticular, Bone Marrow and Urogenital Paracoccidioidomycosis"],"prefix":"10.1111","volume":"69","author":[{"given":"Wdson Luis Lima","family":"Kruschewsky","sequence":"first","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Department Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariane Cappellini","family":"Stricagnolo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the Municipal University of S\u00e3o Caetano do Sul  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f4nica Scarpelli Martinelli","family":"Vidal","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Mycology \u2010 LIM\u201053, Institute of Tropical Medicine, Division of Dermatology, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Benard","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Mycology \u2010 LIM\u201053, Institute of Tropical Medicine, Division of Dermatology, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2097-389X","authenticated-orcid":false,"given":"V\u00edtor Falc\u00e3o","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Department Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"},{"name":"Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo, Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago Alexandre","family":"Cocio","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Mycology \u2010 LIM\u201053, Institute of Tropical Medicine, Division of Dermatology, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Satie Gon\u00e7alves Kono","family":"Magri","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Department Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"},{"name":"Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo, Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7996-8265","authenticated-orcid":false,"given":"Marcello Mihailenko Chaves","family":"Magri","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Tropical Medicine Department Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"},{"name":"Faculty of Medicine of the Municipal University of S\u00e3o Caetano do Sul  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1590\/0037\u20108682\u20100230\u20102017"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0036\u201046652015000700004"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00233\u201021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijd.ijd_830_22"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/961984"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_8_1","first-page":"211","volume-title":"Paracoccidiodomicose","author":"Baransky M. 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