Oral Lesions - Leading Diagnosis of Disseminated Histoplasmosis.

ABSTRACT

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.