Oral Lesions - Leading Diagnosis of Disseminated Histoplasmosis.

Histoplasmosis is a systemic mycotic infection caused by Histoplasma capsulatum. Although rare in India, it is endemic in over 300 countries. If immunity is good in a healthy person, even if this fungus is inhaled, it may cause mild symptoms and can be controlled by supportive therapy. However, in persons with very low immunity, as in the case of human immunodeficiency virus-positive persons, a serious disseminated form could be life-threatening in delayed diagnosis and delay in proper treatment. Due to pulmonary symptoms, it is commonly misinterpreted as tuberculosis and treated accordingly without results. However, oral lesions which occur can reveal the correct diagnosis by biopsy procedure and microscopic confirmation of this rare disease. We had a 76-year-old patient suffering from pulmonary signs of cough, weakness, and with gums and tongue lesions, who was referred by a general dental practitioner for diagnosis of oral lesions. The tongue and gums lesions biopsy revealed the correct diagnosis of granulomatous lesion with yeast-like organisms of giant cells, indicating histoplasmosis capsulatum diagnosis which was later treated by immunology experts in the hospital with proper antifungal agents like amphetericin B and management of this disseminated histoplasmosis with other investigations. Therefore, systemic diseases also need oral examination to rule out many unusual diseases.

Transmigration of the Mandibular Canine: A Report of Two Rare Cases.

When the tooth, instead of erupting in its normal position, remains impacted and crosses midline and is seen on the opposite side of the jaw, it is termed as Transmigration; e.g., right side tooth is seen on the left side and vice-versa. This phenomenon occurs without any pathology intervening cause. Canines are commonly seen unerupted and remain impacted, but rarely seen crossing the midline and migrating to the opposite side. They are usually symptomless. Here, we present two such rare cases of transmigration of the mandibular canine, one from the right side to the left side and appearing piercing the lower border of the mandible and producing a hard bulge on the left side of the lower jaw, but without any pain. The other case is of transmigration of mandibular left canine toward the right side well below the inferior alveolar canal beyond mental foramen facing toward posterior region of the mandible and causing pain symptoms in the jaw due to its close proximity to inferior alveolar canal. It is very essential to have panoramic radiograph to detect such abnormalities at an early stage to plan treatment and avoid future complications. Cone beam computed tomography images also play an important role.