Coinfection of paracoccidioidomycosis and mucocutaneous leishmaniasis: a case report and systematic review

BackgroundSystemic mycoses and neglected tropical diseases, such as paracoccidioidomycosis (PCM) and leishmaniasis, remain major public health concerns in endemic regions of Latin America. Their coinfection is exceptionally rare and scarcely reported although these infections share overlapping ecological niches and risk factors across multiple endemic countries, including Colombia.MethodsWe report the first documented case of coinfection by PCM and mucocutaneous leishmaniasis in an elderly male agricultural worker from a tropical endemic region in Colombia. The patient presented with upper gastrointestinal bleeding, chronic respiratory symptoms, long-standing nasal and oral mucocutaneous lesions, and severe malnutrition. A systematic literature review was also conducted following PRISMA guidelines to identify all previously reported cases of PCM–leishmaniasis coinfection up to April 2026. The review protocol was registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/9T5GM).ResultsHistopathological examination established pulmonary PCM, and additional nasal and oral lesions biopsies confirmed mucocutaneous leishmaniasis with granulomatous PCM involvement. The systematic review identified 381 records, from which only two previously published cases were eligible; three cases were analyzed together with the index case. All patients were adult males from endemic areas with relevant environmental exposure and no evidence of a recognized immunosuppressive disorder or immunosuppressive therapy. The clinical manifestations were highly heterogeneous, ranging from localized mucocutaneous involvement to disseminated disease with pulmonary and laryngeal compromise. Notably, the Colombian case expanded the known clinical spectrum by including upper gastrointestinal bleeding and severe malnutrition. In all cases, the diagnosis relied on histopathological confirmation, and treatment with amphotericin B followed by itraconazole resulted in favorable clinical outcomes.ConclusionPCM–leishmaniasis coinfection is a rare but clinically significant entity that poses important diagnostic challenges, particularly in endemic settings. This case highlights the diagnostic challenges posed by overlapping clinical presentations and underscores the importance of maintaining a high index of suspicion and performing comprehensive diagnostic evaluations in patients from regions where both infections may coexist.