International Journal of Infectious Diseases 17 (2013) e139–e140
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Medical Imagery
Primary localized histoplasmosis: oral manifestations in immunocompetent patients
A 30-year-old previously healthy man was admitted to our hospital with a large ulcer with granulomatous aspect on the lateral border of the tongue that had started 1 month ago (Figure 1A). He also complained of fever and weight loss. The second patient was a 70-year-old man, referred by his general dentist for evaluation of a painful oral lesion. The clinical oral examination revealed an ulcerated red lesion located on the tongue (Figure 1B). The last patient, a 50-year-old-man, presented to our hospital complaining of large tongue lesions. Examination of the oral cavity revealed two crater-like ulcers, with an inflamed base and regular, elevated, well demarcated and hard borders. The right
lesion was 3 cm in diameter at its widest and was located in the central region of the tongue. Another ulcerated lesion with the same characteristics was observed in the anterior region (Figure 1C). All three patients were submitted to an incisional biopsy. Microscopically, all lesions showed a focally ulcerated mucosa, with overlying fibroconnective tissue containing a few multinucleated giant cells. As part of the microscopic evaluation, staining with Gomori’s methenamine silver was performed, and all samples were positive for a fungus morphologically characteristic of Histoplasma capsulatum (Figure 2).
Figure 1. A Ulcerated lesion with a granular surface on the lateral border of the tongue. (B) Large erythematous lesion with an elevated, ulcerated, reddish surface, and irregular margins involving the tongue. (C) Two crater-like ulcers, with inflamed base and elevated hard borders.
Figure 2. A Low-power photomicrograph of a specimen shows non-caseating granulomatous inflammation with giant cells (hematoxylin and eosin stain, original magnification 200). (B) Multinucleated giant cell containing numerous small circular yeast-like bodies (Gomori’s methenamine silver stain, original magnification 400). 1201-9712/$36.00 – see front matter ß 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijid.2012.11.004
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Medical Imagery / International Journal of Infectious Diseases 17 (2013) e139–e140
Oral histoplasmosis has been recorded in immunocompromised patients,1,2 mainly in HIV-seropositive patients, and may be the first manifestation of AIDS.1–4 In this report, all patients consented to an HIV serology test, all of which were negative, and no patient showed pulmonary manifestations or disseminated disease. Conflict of interest: No conflict of interest to declare. Acknowledgements We would like to thank the Oral Pathology Service of the School of Dentistry, Federal University of Uberlaˆndia, for providing the histopathology images.
3. Alcure ML, Di Hipo´lito Ju´nior O, Almeida OP, Bonilha H, Lopes MA. Oral histoplasmosis in an HIV-negative patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e33–6. 4. Akin L, Herford AS, Cicciu` M. Oral presentation of disseminated histoplasmosis: a case report and literature review. J Oral Maxillofac Surg 2011;69:535–41.
Luiz Fernando Barbosa de Paulo* Roberta R. Rosa Antoˆnio F. DurighettoJu´nior Department of Head and Neck Pathology, Federal University of Uberlaˆndia, Av Para˜, HC, Bloco 2U, Uberlaˆndia, Brazil *Corresponding author E-mail address:
[email protected] (L.F. Barbosa de Paulo).
References Corresponding Editor: Eskild Petersen, Skejby, Denmark 1. Ge L, Zhou C, Song Z, Zhang Y, Wang L, Zhong B, Hao F. Primary localized histoplasmosis with lesions restricted to the mouth in a Chinese HIV-negative patient. Int J Infect Dis 2010;14(Suppl 3):e325–8. 2. Ferreira OG, Cardoso SV, Borges AS, Ferreira MS, Loyola AM. Oral histoplasmosis in Brazil. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:654–9.
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