Histoplasmosis in the nasal septum without pulmonary involvement in a patient with acquired immunodeficiency syndrome: case report and literature review

Oikawa, Fernando Teiichi Costa; Carvalho, Daniela; Matsuda, Nilce Mitiko; Yamada, André Fukunishi

doi:10.1590/s1516-31802010000400012

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…In 2006 Motta et al reported the case of a renal transplanted patient with ulcers in the nasal and oral mucosa as the sole manifestation of histoplasmosis [3]. In 2010 Oikawa et al carried out a review of the literature, searching for articles in four different databases, and found only three case reports of histoplasmosis with compromised nasal septum [4]. In 2012 Manzini and Lavinsky-Wolff reported the case of an immunosuppressed patient with lesions of the nasal mucosa caused by the fungus, without pulmonary manifestations [5].…”

Section: Discussionmentioning

confidence: 99%

Nasal septum ulcer as an isolated manifestation of histoplasmosis

Pedroso

Araújo

Crespo

et al. 2019

IDCases

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HighlightsThe purpose of this report is to describe an unusual case of nasal septum ulcer as an isolated manifestation of histoplasmosis, which stands out from most common forms, such as pulmonary or disseminated ones.In order to investigate an isolated septal lesion we must consider several diagnostic hypotheses, among them, leprosy, tuberculosis, paracoccidioidomycosis, Wegener’s granulomatosis, leishmaniasis, as well as histoplasmosis.A broad clinical investigation is important for the correct diagnosis and early therapy, considering that immunocompromised patients present a higher risk of progression to the disseminated form of the disease, with high mortality rates.

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Section: Discussionmentioning

confidence: 99%

Nasal septum ulcer as an isolated manifestation of histoplasmosis

Pedroso

Araújo

Crespo

et al. 2019

IDCases

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“…The destruction of nasal cartilage is the result of hematogenous dissemination of the fungus spores, triggering a cascade of pro-inflammatory cytokines and the cytogenetic effects generated by tissue macrophages, lymphocytes and neutrophiles that progressively destroy the fine and delicate nasal cartilage [14].…”

Section: Discussionmentioning

confidence: 99%

Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS

Escalante

Granizo-Rubio

Pinos-León³

et al. 2022

BMC Infect Dis

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Background Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. Case presentation We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. Conclusions Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.

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“…Histoplasmosis can infect multiple systems, including the central nervous system [9], articulation [6], and bone marrow, as well as nasal septum [10] and skin [11]. Occasionally it can lead to variable symptoms or even fatal outcomes, such as adrenal insufficiency induced by adrenal gland lesions [12], dysphagia induced by laryngopharyngeal nodular mass [5,13] or renal failure induced by granulomatous interstitial nephritis [14].…”

Section: Discussionmentioning

confidence: 99%

Colonic involvement in disseminated histoplasmosis of an immunocompetent adult: case report and literature review

Yang

et al. 2013

BMC Infect Dis

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BackgroundHistoplasmosis is a common opportunistic fungal infection that is observed almost exclusively in immunodeficient patients, especially those with AIDS. Immunocompetent individuals that suffer from histoplasmosis are rarely reported, especially those with disseminated lesions, such as disseminated histoplasmosis. The observation of disseminated histoplasmosis with prominent gastrointestinal involvement, no respiratory symptoms (which is presumed to be the portal of infection), gastrointestinal pathological changes, and minor digestive system disorders make this case study exceedingly rare.Case presentationWe report the case of a 33-year-old immunocompetent male who presented with fever and weight loss. Based on investigations, the patient showed pancytopenia, hepatosplenomegaly, bone marrow involvement and marked colonic involvement. Finally, disseminated histoplasmosis was diagnosed and confirmed by stained smears of fine needle aspirates and biopsy from lesions in the bone marrow and colon. The patient showed appreciable regression of lesions following prompt treatment with amphotericin B deoxycholate, and was treated thereafter with oral itraconazole following discharge from hospital.ConclusionDisseminated histoplasmosis could be underestimated in immunocompetent patients. A high degree of clinical suspicion is essential in both immunocompromised and immunocompetent patients, regardless of pulmonary symptoms, and whether in endemic or non-endemic areas. Early and accurate diagnosis is extremely important for the appropriate treatment of infection and to improve disease outcome.

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Histoplasmosis in the nasal septum without pulmonary involvement in a patient with acquired immunodeficiency syndrome: case report and literature review

Cited by 9 publications

References 18 publications

Nasal septum ulcer as an isolated manifestation of histoplasmosis

Nasal septum ulcer as an isolated manifestation of histoplasmosis

Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS

Colonic involvement in disseminated histoplasmosis of an immunocompetent adult: case report and literature review

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