A case of primary oral histoplasmosis? / 中华皮肤科杂志

ABSTRACT

The patient,a 51-year-old veterinarian,was hospitalized for a two-month history of painful oral ulcers without fever.Physical examination revealed two superficial ulcers in the palate.Laboratory examination showed a decrease in peripheral blood leucocytes as well as a hyperplasia of bone marrow.No abnormality was found by X-ray radiography or B-mode ultrasonography.The paileat tested negative for anti-HIV antibody.Classification Of CD+ cells showed that CD3+ cells amounted to 0.559,CD4+ cells 0.289,CD8+ cells 0.207,CD4CD8 ratio 1.4,and all the parameters were in a normal range.Histopathological analysis of the ulcer tissue revealed a chronic inflammatory granuloma with clustered yeast-like cells.Fungal culture of the sample from ulcer tissue at 25℃on the slant of PDA yielded white filamentous colony;typical rudder-like macroconidias were observed with electronic microscopy following microculture;and the isolate showed a biphasic growth pattern.PCR was performed to amplify the internal transcribed spacer 1 (ITS1)and D1/D2 region of the isolated fungus followed by sequence analysis,and a homology of 97%and 99%was observed in the sequence of ITS1 and D1/D2 region,respectively,between the isolate and standard strain of Histoplasma capsulatum.A diagnosis of primary oral histoplasmosis Was made.The lesions subsided after 2-month treatment with oral itraconazole 400 mg per day.