Gustavo Antonio Correa Momesso1, Tárik Ocon Braga Polo1, Valthierre Nunes de Lima1, Cecília Alves de Sousa1, Ana Maria Pires Soubhia2, Ellen Gaetti Jardim3, Leonardo Perez Faverani1. 1. Divisão de Cirurgia Oral e Maxilofacial do Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Júlio de Mesquita Filho" - Araçatuba (SP), Brasil. 2. Divisão de Patologia Oral, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Júlio de Mesquita Filho" - Araçatuba (SP, Brasil. 3. Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul - Campo Grande (MS), Brasil.
To the editor,Histoplasmosis is an opportunistic fungal infection, endemic to Latin America, that is
caused by Histoplasma capsulatum. This infection mostly occurs in the
lungs( and is frequently
associated with AIDS.( Sometimes,
histoplasmosis is misinterpreted with tuberculosis due to their clinical
similarities.( Oral involvement is very rare in histoplasmosis, being
associated only with its disseminated form.(A 60-year-old white patient was referred to the Oral and Maxillofacial Surgery team of
the Faculdade de Odontologia of the Universidade Estadual
Paulista "Julio de Mesquita Filho" (UNESP, Araçatuba, SP, Brazil)
for evaluation of lesions scattered on the tongue, hard palate and skin. Clinical
examination showed a prostrated and immunosuppressed patient with feeding difficulty.
Oral examination revealed ulcerated lesions, caries and purulent exudate on the dorsal
surface of tongue and on the hard palate. In addition, an erosive whitish lesion,
typical of opportunistic lesions, was observed on the skin of the left forearm. A tongue
biopsy was carried out for histopathological analysis in addition to the routine
laboratory exams that were prescribed. The rapid HIV test and the specific test (Western
blot) were positive, confirming a diagnosis of AIDS (Figures 1A, 1B and 1C).
Figure 1
(A to C) Lesions scattered on the tongue, hard palate and skin. (D)
Histopathological analysis showed the presence of clear haloes and
hyphae.
(A to C) Lesions scattered on the tongue, hard palate and skin. (D)
Histopathological analysis showed the presence of clear haloes and
hyphae.The routine histopathological analysis showed the presence of clear haloes and hyphae,
which, in combination with the clinical characteristics, confirmed a diagnosis of
histoplasmosis (Figure 1D). Drug treatment was
initiated with three daily mouth washes of nystatin (500,000IU), and the patient was
referred to the medical clinic for AIDS treatment. A month later, the family reported
that the patient had died.Early diagnosis of histoplasmosis is important for improving the patient's quality of
life. The timely discovery of oral lesions helps physicians treat the symptoms of
HIV-positivepatients, in addition to being a clinical predictor of AIDS with systemic
symptoms. In the present case, the patient's delayed search for medical assistance led
to a late diagnosis, which was decisive for the case prognosis.
Figure 1