An elderly female presented with chronic, non-healing finger lesions, initially suspected to be bacterial. Routine bacterial culture surprisingly revealed a dimorphic fungus. Further investigation, including histopathology and molecular testing, identified Paracoccidioides brasiliensis, leading to a diagnosis of cutaneous paracoccidioidomycosis. This case was complicated by the patient's comorbidities, which limited first-line therapeutic options. The diagnosis was unexpected, highlighting the importance of considering unusual pathogens in chronic skin infections, especially in patients with relevant epidemiological history.
Key note: Chronic, non-healing lesions, even when initially suggestive of bacterial etiology, warrant a broad diagnostic approach, including fungal cultures, particularly for dimorphic fungi.