A gingival manifestation of histoplasmosis leading diagnosis

Abstract

Histoplasmosis is a world-wide distributed deep mycosis caused by Histoplasma capsulatum which has been endemic in many countries. We present a case involving an immunocompetent man evidencing the necessity of a multidisciplinary approach and rational requisition of exams. The disease has started as a pulmonary disease mimicking tuberculosis, although the exams have been negative. Immunodiffusion test indicate histoplasmosis, not confirmed by culture of sputum. After days the patient was forwarded by a private doctor for evaluation of oral lesions at our Department of Stomatology. An incisional biopsy revealed a nonspecific granulomatous inflammation and the Grocott-Gomori methenamine silver stain identified scarce oval structures that could represent fungal yeast. Sampling oral lesions with swab, it was observed the typical growth of H. capsulatum on culture. This case highlights the importance of doctor's integration diagnosing histoplasmosis, while a wide spectrum of clinical manifestations should be expected. Oral lesions may be the critical manifestation leading diagnosis.

Tonsillar ulceration as manifestation of disseminated African histoplasmosis in an immunocompetent Portuguese host

“…There are several cases worldwide reported with oral histoplasmosis in immunocompetent patients [7] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . In Portugal, only one case was published about an oral histoplasmosis in a hemodialysis patient with persisted fever [9] .…”

Clinical features and endemic trend of histoplasmosis in China: A retrospective analysis and literature review

“…If patients had only 1 involved leision and lacked constitutional symptoms or physical signs, that would be defined as focal histoplasmosis. When existence of histoplasmosis capsulatum is confirmed in bone marrow or blood, or in one viscus with systemic complaint or in two uncontaminated viscera, that would be defined as progressive disseminated histoplasmosis . Patients with suspicious diagnosis of histoplasmosis without finding these fungi in bone marrow or other tissues would be excluded.…”

“…When existence of histoplasmosis capsulatum is confirmed in bone marrow or blood, or in one viscus with systemic complaint or in two uncontaminated viscera, that would be defined as progressive disseminated histoplasmosis. 10 Patients with suspicious diagnosis of histoplasmosis without finding these fungi in bone marrow or other tissues would be excluded. Immunocompromise was defined as a prior in the presence of one of the seven criteria: (1) neutropenia, (2) solid organ or hematopoietic stem cell transplantation, (3) immunosuppressive medications (chronic glucocorticoids, antirejection medications, antineoplastic, et al), (4) cirrhosis, (5) human immunodeficiency virus (HIV), (6).…”