Oropharyngeal histoplasmosis: report of eleven cases and review of the literature

Abstract

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.

Disseminated Histoplasmosis: A Challenging Differential Diagnostic Consideration for Suspected Malignant Lesions in the Digestive Tract

“…Therefore, it appears crucial for clinicians to be aware that an oropharyngeal or laryngeal presentation of histoplasmosis may be the only apparent clinical sign of dissemination [10]. Patients suffer from hoarseness and dysphagia caused by indurated, ulcerated lesions mimicking cancer [11]. In addition, a differential diagnostic consideration should include tuberculosis, other fungal diseases, such as coccidioidomycosis and blastomycosis, and viral infection, such as coxsackievirus or herpes virus infection.…”

Progressive disseminated histoplasmosis in an immunocompetent adult: A case report

“…Oropharyngeal involvement is seen in 30-40% of cases of PDH and most commonly involves buccal mucosa (54.8%) followed by tongue and palate (6). Involvement of pharynx and larynx is rare.…”

Histoplasmose simulando neoplasia primária de pulmão ou metástases pulmonares

“…There are sporadic reports of patients with histoplasmosis that have been misdiagnosed as having head and neck cancer, ( 2 , 12 ) primary lung cancer, ( 13 - 15 ) or lymphoma. ( 16 , 17 ) In such cases, the cytological examination of the pleural fluid can suggest neoplasia, because giant cells in which H. capsulatum is present could be mistaken for malignant lymphoblasts.…”