Chronic disseminated histoplasmosis with lesions restricted to the mouth: case report

Abstract

We report a rare case of chronic disseminated histoplasmosis with several ulcerated lesions in the oral cavity in an alcoholic patient without human immunodeficiency virus infection, with no detectable signs and symptoms of systemic disease or extraoral manifestations. Histopathological analysis revealed chronic inflammatory process with granulomas containing Histoplasma-like organisms. The isolation of Histoplasma capsulatum provided the definitive diagnosis. Treatment with itraconazole resulted in complete remission of oral lesions. As far we aware, this is the second case report of oral histoplasmosis in an HIV negative patient described in Brazil.

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

“…In seven cases, clinical or microbiological pulmonary involvement was observed concomitant with oral histoplasmosis. Regarding patients with AIDS, four of the five described presented microbiological or histopathological evidence of DH, proving the strong association between DH and immunocompromised patients, as reported in literature 1,3,7 . Four (36.4%) patients had a history of active pulmonary tuberculosis when the diagnosis of DH was made.…”

“…Histoplasmosis is a worldwide systemic mycosis caused by Histoplasma capsulatum, a dimorphic fungus that has been isolated from soil contaminated with bird or bat droppings in endemic areas, as reported in Brazil and central United States [1][2][3][4] . Infection occurs almost exclusively by inhalation of airborne conidia or mycelial fragments [1][2][3][4] .…”

“…Infection occurs almost exclusively by inhalation of airborne conidia or mycelial fragments [1][2][3][4] . The course of histoplasmosis can be influenced by the immune status of the host and by the quantity of infective propagules the host is exposed to 1,5,6 .…”

Histoplasmosis masquerading as solitary oral ulcer: An unusual case report

“…[3,5] The course of the disease is infl uenced by the host immune status and by their exposure to infective propagules and has a wide spectrum of clinical manifestations, ranging from asymptomatic infection to severe disseminated disease depending on the size of the inoculums, immune status of the aff ected individual, and the virulence of the fungal strain. [4] In 1982, histoplasmosis was fi rst reported in patients with acquired immune defi ciency syndrome (AIDS) and, since 1987 extra-pulmonary histoplasmosis in an individual with a positive serologic test for HIV is a case defi nition of AIDS according to the centers for disease control. [5] Immune compromised individuals have a generalized form of the disease involving multiple organs and less frequently oral lesions may be the only manifestation of the disease.…”

“…In such cases diagnoses are based on histology with specifi c stains, culture of organisms, and also complement-fi xing antibodies in serum. [4] Case Report A 60-year-old male patient reported to the outpatient Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet, with a painful ulcer in his left cheek since about 5 months. The ulcer had begun as a raised lesion, which ulcerated.…”