Oral histoplasmosis of a healthy man in a non-endemic area

Excerpt

A 67-year-old man presented with a slightly painful erythematous lesion with an elevated, ulcerated, micropapillary surface, and irregular margins localized at the hard palate (Fig. 1). The lesion had suddenly appeared 6 months earlier, but was slowly progressive. He had no history of drinking or smoking habit, or primary or secondary immunodeficiency. On physical examination, no regional and extra-regional lymphadenopathy or organomegaly was detected. Routine blood tests just revealed a mild anemia (10.2 g/dL, normal range 12–14 g/dL), whereas serum antibodies against HIV, HBV, HCV, EBV, CMV, leishmaniasis, tuberculosis (TB), and syphilis were all negative. TB was also excluded via histology with Ziehl–Neelsen staining, chest X-ray, and enzyme-linked immunospot; leishmaniasis was excluded via histology with Giemsa staining. Head and neck computed tomography (CT) scan did not show any further abnormalities. No history of travelling over the past 12 months was reported. The histological examination revealed the presence of Histoplasma capsulatum (HC) (Fig. 2). The high titer of anti-HC antibodies, the absence of any systemic signs or symptoms, and negative results of blood tests and total body CT scan led to a diagnosis of localized oral histoplasmosis. The patient received itraconazole 200 mg orally, twice daily for 2 months, and entered complete and long-lasting clinical remission. Oropharyngeal lesions of histoplasmosis are quite rare and may also affect immunocompetent patients, representing the initial manifestation of a disseminated form [1]. A prompt differential diagnosis including all productive/ulcerative oropharyngeal lesions, even in such patients who live in non-endemic areas, might prevent the dissemination.

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