1/20. Orofacial manifestations of histoplasmosis in hiv-positive patients: a case report.Amongst the main opportunistic diseases that affect the hiv-positive patient, histoplasmosis is found. This systemic mycosis caused by the fungus histoplasma capsulatum has the capacity to disseminate from the lung to the skin and oral mucosa. Oral lesions of histoplasmosis can be found with ulcerated or nodular aspect, being always very painful and infiltrating the mucosa. When they are present in the mouth, they strongly indicate the presence of some kind of immunosuppression. This study shows the disease's evolution in an hiv-positive patient, who presented several ulcerated lesions in the oral cavity and facial skin. The symptomatology and clinical aspects of the lesions were not specific for the disease, and due to this, the diagnosis was obtained by cytological smear and oral biopsy. The results of the exams defined the disseminated picture of the infection. The treatment plan involved the use of amphotericin b for the lesions' remission, and, following this, itraconazole was administered in the maintenance phase.- - - - - - - - - - ranking = 1keywords = oral cavity, mouth, cavity (Clic here for more details about this article) |
2/20. Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome.A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (hiv) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including histoplasma antibodies, toxoplasmosis immunoglobulin m (IgM), rapid plasma reagin (RPR), hepatitis c virus (HCV), and hepatitis b virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin b was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin b for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her hiv infection during hospitalization. After amphotericin b therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.- - - - - - - - - - ranking = 0.9484833199762keywords = oral cavity, cavity (Clic here for more details about this article) |
3/20. histoplasmosis in australia: a report of a case with a review of the literature.histoplasmosis is a rare but serious fungal infection commonly presenting as mucosal ulceration of the oral cavity. It is increasingly recognized in australia but the source of infection remains obscure and it is likely to be under-diagnosed. We report a case of chronic mucosal ulceration which failed to fully respond to periodontal therapy. histology and culture of a gingival biopsy was consistent with histoplasmosis, and the patient responded favourably to treatment with oral itraconazole. histoplasmosis may present to general dental practitioners as chronic mucosal ulceration and should be considered in the differential diagnosis of such lesions. diagnosis is best made by culture and histology of biopsy specimens.- - - - - - - - - - ranking = 0.9484833199762keywords = oral cavity, cavity (Clic here for more details about this article) |
4/20. Oral histoplasma capsulatum infection in association with hiv infection: a case report.The fungus histoplasma capsulatum causes histoplasmosis, the most common endemic respiratory mycosis in the united states. Disseminated histoplasmosis in adults is often associated with immunosuppression, such as occurs in hiv infection. We report a case of oral histoplasmosis in an hiv-seropositive patient who presented with an ulceration on the left tip of the tongue, extending to the floor of the mouth, but was otherwise free of any active systemic disease. histoplasma capsulatum was shown, by both histopathology and staining with a fluorescent antibody reagent specific for the organism, to be present in the lesion and was deduced to be the causative organism.- - - - - - - - - - ranking = 0.051516680023797keywords = mouth (Clic here for more details about this article) |
5/20. Oral histoplasmosis presenting as oral ulcer in a non-hiv patient.A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like hiv, the present case was negative for hiv. histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly malaysia. Thirty-seven cases of histoplasmosis were reported from malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.- - - - - - - - - - ranking = 0.051516680023797keywords = mouth (Clic here for more details about this article) |
6/20. Nasal histoplasmosis in the acquired immunodeficiency syndrome.Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegener's granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.- - - - - - - - - - ranking = 0.9484833199762keywords = oral cavity, cavity (Clic here for more details about this article) |
7/20. Chronic disseminated histoplasmosis with lesions restricted to the mouth: case report.We report a rare case of chronic disseminated histoplasmosis with several ulcerated lesions in the oral cavity in an alcoholic patient without human immunodeficiency virus infection, with no detectable signs and symptoms of systemic disease or extraoral manifestations. Histopathological analysis revealed chronic inflammatory process with granulomas containing histoplasma-like organisms. The isolation of histoplasma capsulatum provided the definitive diagnosis. Treatment with itraconazole resulted in complete remission of oral lesions. As far we aware, this is the second case report of oral histoplasmosis in an hiv negative patient described in brazil.- - - - - - - - - - ranking = 1.1545500400714keywords = oral cavity, mouth, cavity (Clic here for more details about this article) |
8/20. Disseminated histoplasmosis in an immunocompetent individual--a case report.We report a rare case of disseminated histoplasmosis in a immunocompetent young adult person involving bone marrow, liver, spleen and oral cavity. He presented with oral ulcers, weight loss and pancytopenia. His bone marrow aspiration examination revealed histoplasma capsulatum.- - - - - - - - - - ranking = 0.9484833199762keywords = oral cavity, cavity (Clic here for more details about this article) |
9/20. Histoplasmic endophthalmitis. A clinicopathologic correlation.A patient had a 12-year history of relapsing disseminated histoplasmosis. None of the characteristic lesions of the presumed ocular histoplasmosis syndrome were present in either eye. Ocular involvement began as a peripheral focal retinitis associated with vitreitis and iritis. histoplasma capsulatum organisms grew in cultures from aqueous and vitreous and were demonstrated histologically in an iridectomy specimen. Despite intraocular and subconjunctival administration of amphotericin b, intractable pain associated with progressive necrotizing granulomatous iridocyclitis necessitated enucleation. histoplasma capsulatum organisms were seen extracellularly in the vitreous cavity and both intracellularly and extracellularly in areas of granulomatous inflammation involving the iris, ciliary body (diffusely), and the retina (focally). The choroid was not involved.- - - - - - - - - - ranking = 0.022519069839269keywords = cavity (Clic here for more details about this article) |
10/20. Ulcerated lesion of the alveolar ridge.histoplasmosis is a generalized fungal infection that is caused by the organism H capsulatum. In the most common disease-producing mechanism, the organism is inhaled and lodges in the lung, where it initiates an inflammatory focus. The peribronchial lymph nodes are subsequently involved, forming a primary complex that may ultimately calcify and become radiographically evident. From the primary complex, dissemination by the bloodstream may lead to colonization elsewhere. In the less frequent disease-producing complex, the organism is introduced directly into the tissue through a break in its continuity. A primary complex is then formed by involvement of the lymph nodes. Dissemination from such a focus is rare. It is generally believed that oral and pharyngeal lesions of the histoplasmosis represent symptoms of a systemic disease and are not a localized form of the disease. histoplasmosis can occur at all ages; however, it is more often found in infancy and old age, especially in white males. Any area in the oral cavity may be affected; the most common sites are: larynx, tongue, palate, buccal mucosa. gingiva, and pharynx. The most frequently reported symptoms are pain, hoarseness, loss of weight, ulcer, and sore throat. The appearance of the oral and pharyngeal lesions may vary and may manifest as ulcers, nodules, or verrucous plaques. Deep, indurated ulcers are common, accounting for the predominant clinical impression of squamous carcinoma.- - - - - - - - - - ranking = 0.9484833199762keywords = oral cavity, cavity (Clic here for more details about this article) |
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