Geotrichosis of oral mucosa

Abstract

Summary. A livid, sharply defined enanthema of the oral mucosa with ulcerations on the soft palate in a patient presenting with de novo acute myeloid leukaemia with prolonged, therapy‐induced granulocytopenia (lt 0.5 nl‐1 for 113 days!) was diagnosed as geotrichosis. Geotrichum capitatum was identified both in vivo and in vitro. Pneumonic infiltrates in the upper lobes of both lungs were treated with amphotericin B infusions. Healing of the aforementioned enanthema was only achieved after addition of 5‐fluorocytosine to therapy. Susceptibility determinations with several Geotrichum capitatum isolates led to the conclusion that amphotericin B was unsuitable as a therapeutic agent in this case. 5‐Fluorcytosine and itraconazole exhibited superior antifungal and antimycotic activity. Zusammenfassung. Ein livides, scharf begrenztes Enanthem der Mundschleimhaut mit Ulzerationen am weichen Gaumen bei einer de novo akuten myeloischen Leukämie mit extrem langer, therapiebedingter Granulozytopenie (lt 0.5 nl‐1über 113 Tage!) wird als Geotrichose angesehen. Geotrichum capitatum wurde in vivo und in vitro nachgewiesen. Pneumonische Infiltrate in beiden Lungenoberlappen waren Anlaß zu einer Infusionstherapie mit Amphotericin B. Eine Abheilung des obengenannten Enanthems wurde allerdings erst nach Umstellung der Therapie auf 5–Fluorcytosin‐Infusionen erzielt. Resistenzbestimmungen mit mehreren Isolaten hinterließen den Eindruck, daß Amphotericin B als Therapeutikum hier nicht geeignet war. 5–Fluorcytosin und Itraconazol zeigten einen besseren antimyzetischen Effekt und antimykotische Wirksamkeit.

Oral geotrichosis: report of 12 cases

“…This clinical manifestation was very different from candidiasis, which is more superficial, and bore a close resemblance to ulcers caused by zygomycosis and aspergillosis, resulting in a very aggressive palatinecerebral condition with a poor prognosis (20). This has been reported for some patients (19) with esophageal ulcerations (21); oral ulcers in dogs have also been reported (22).…”

“…However, associated factors indicated that most of the cases occurred among diabetic patients, in addition to patients with leukemias, lymphomas and HIV-AIDS. Most of these conditions have been reported in the literature (4,(16)(17)(18)(19), and it is important to emphasize that they are the background diseases most frequently associated with oral candidiasis. With regard to the course of the disease, there is a subacute stage that lasts for about 8 days, also similar to cases of candidiasis.…”

“…The most common symptoms were burning pain and impaired swallowing. On the basis of the clinical features, this entity is (16)(17)(18)(19). Two cases with a villous hyperplastic manifestation, similar to viral disease and candidiasis, drew our attention.…”

Candidiasis and other fungal diseases of the mouth

“…The oral lesions of geotrichosis are indistinguishable clinically from those of acute pseudomembranous candidiasis (thrush), and the reported low incidence of the disease may be due to such misdiagnosis. Other reports indicate that the clinical appearance is as edematous and erythematous gingivae (91) and ulcerations (92). In one study it was the second most common oral yeast isolated from patients with hematologic malignancies suffering from stomatitis (93).…”

Diagnosis of Aging Skin Diseases

“…Reports on mortality vary from minimal if the underlying immunosuppression is resolved, to approximately 75% in immunosuppressed patients [82,92]. While amphotericin B has provided moderate success in treatment, the current preferred regime includes 5-fluorocytosine and itraconazole [93].…”