Características histopatológicas e imunohistoquímicas das lesões cutâneas e da mucosa oral na histoplasmose disseminada de portadores da síndrome da imunodeficiência adquirida (AIDS)

D'Ávila, Solange Corrêa Garcia Pires; Chapadeiro, E

doi:10.1590/s0037-86821998000600006

Cited by 4 publications

(2 citation statements)

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“…También se h a visto en las vegetaciones fibrinoides, acelulares, de las endocarditis histoplasmósicas (7). Debe ser combatido por la inmunidad celular a través de una respuesta de tipo THI (8,9). Como estafase de la respuesta inmune es la más afectada en el sida, la aparición de HD es posible y frecuente en estos enfermos (8), que tienen mayor riesgo de La HD es una enfermedad grave en la que el hongo predomina en órganos ricos en macrófagos, por lo cual es común que curse con adenopatías, hepatoesplenomegalia y con leucopenia, anemia y plaquetopenia, secundarias al compromiso de la médula ósea.…”

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“…En la criptococosis cutánea asociada con el sida, las lesiones macroscópicas son pápulas o nódulos de centro deprimido y la histopatologia muestra enorme número de Cryptococcus neoformans dentro de los macrófagos, con cápsulas claras, gruesas, sin estructura a la HE, que se tiñen con el azul alciano o con el mucicarmín (6,9), único hongo con esta característica. La impresión general de la biopsia es la de una lesión cutánea repleta de material mucoide claro y sin inflamación (14), pero muy rica en hongos.…”

Section: Discussionunclassified

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Estudio histopatológico de 19 biopsias cutáneas de pacientes con sida e histoplasmosis diseminada

Rodríguez

Motta²,

Ordóñez³

2001

biomedica

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La histoplasmosis diseminada (HD) compromete la piel y la mucosa oronasofaríngea con alta frecuencia. Entre 1.800 enfermos con sida, 19 presentaron HD, todos con compromiso cutáneo o mucocutáneo. Las lesiones cutáneas fueron máculas, pápulas umbilicadas o escamocostrosas, nódulos y úlceras, en tanto que 42% de los pacientes presentaron ulceras orales. Las biopsias mostraron dermatitis perivasculares superficiales y profundas, nodulares y difusas, foliculitis pustulosa o vasculitis con PMN y leucocitoclasia, con cantidades variables del hongo, fagocitado por macrófagos. En 5 biopsias, Histoplasma ca~sulatum se vio dentro de los nervios cutáneos que estaban rodeados de inflamación variable o tenían perinervio desflecado y estaban invadidos por macrófagos con el hongo. Los principales diagnósticos diferenciales histológicos son: vasculitis leucocitoclásica, criptococosis, aftas, paracoccidioidomicosis y leishmaniasis difusa. Los clínicos, laboratoristas y patólogos deben tener en mente la HD en toda úlcera oral o erupción máculo-papular cutánea de pacientes con sida, pues el diagnóstico rápido de la micosis conduce a un tratamiento oportuno y eficaz, que controla la enfermedad.La biopsia es un procedimiento de diagnóstico rápido, seguro y confiable. H. capsulatum es capaz de invadir los nervios cutáneos.Palabras clave: histoplasmosis diseminada, histoplasmosis y sida, histoplasmosis cutánea. Hlstopathological study of 19 cutaneous biopsies f r o m aids a n d disseminated histoplasmosis patientsDisseminated histoplasmosis (DH) frequently affects the skin and oropharyngeal tissues. Among 1,800 aids patients, 19 had DH, al1 with cutaneous or mucocutaneous lesions. The skin showed macules, umbilicated crusty and scaly papules, nodules and ulcers, while 42% of the DH patients had oropharyngeal ulcers. Skin biopsies showed a variety of inflammatory patterns such as superficial and deep perivascular and nodular and diffuse dermatitis, pustular folliculitis and small vessel vasculitis with leucocytoclastic PMN. In five patients, cutaneous nerves were surrounded by the inflammatory reaction and numerous fungi within macrophages or Schwann cells were seen within the endoneural and perineural tissues. The main differential diagnoses were leucocytoclastic vasculitis, cryptococosis, mucosa1 aftae, paracoccidioidomycosis and diffuse cutaneous leishmaniasis. Clinicians, laboratory workers and pathologists should be aware of DH in HIV+ patients with maculo-papular cutaneous rash or mouth ulcers, since a prompt diagnosis allows a treatment to control the disease. Skin biopsy of these lesions is a rapid, safe and reliable method of diagnosis. H. capsulaturn has the ability to penetrate into cutaneous nerves in some of these patients.

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Section: Discussionunclassified

Estudio histopatológico de 19 biopsias cutáneas de pacientes con sida e histoplasmosis diseminada

Rodríguez

Motta²,

Ordóñez³

2001

biomedica

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Perforation of the Nasal Septum as the First Sign of Histoplasmosis Associated with AIDS and Review of Published Literature

et al. 2013

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Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.

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A nonhealing ulcer of mandibular alveolar ridge

Singh

Gupta

Khatana

et al. 2014

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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Características histopatológicas e imunohistoquímicas das lesões cutâneas e da mucosa oral na histoplasmose disseminada de portadores da síndrome da imunodeficiência adquirida (AIDS)

Cited by 4 publications

References 11 publications

Estudio histopatológico de 19 biopsias cutáneas de pacientes con sida e histoplasmosis diseminada

Estudio histopatológico de 19 biopsias cutáneas de pacientes con sida e histoplasmosis diseminada

Perforation of the Nasal Septum as the First Sign of Histoplasmosis Associated with AIDS and Review of Published Literature

A nonhealing ulcer of mandibular alveolar ridge

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