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Paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in Brazil, is caused by dimorphic fungi of the genus Paracoccidioides and is acquired primarily through inhalation. PCM is associated with a high mortality, particularly among men living in rural areas. This case report describes a 47-year-old man with osteocutaneous involvement diagnosed by biopsy and direct fungal examination. The osseous form of PCM is rare and should be differentiated from other infections and neoplasms. Management involves prolonged antifungal therapy and follow-up for at least two years. This case highlights the diagnostic value of dermatological assessments in atypical presentations of PCM.