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SPCI - Sociedade Portuguesa de Cuidados Intensivos

Revista Brasileira de Terapia Intensiva

AMIB - Associação de Medicina Intensiva Brasileira

OFFICIAL JOURNAL OF THE ASSOCIAÇÃO BRASILEIRA DE MEDICINA INTENSIVA AND THE SOCIEDADE PORTUGUESA DE CUIDADOS INTENSIVOS

ISSN: 0103-507X
Online ISSN: 1982-4335

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Momesso GAC, Polo TOB, Lima VN, Sousa CA, Soubhia AMP, Jardim EG, et al. Histoplasmose oral. Rev Bras Ter Intensiva. 2017;29(3):394-396

 

 

2017;29(3):394-396
LETTERS TO THE EDITOR

10.5935/0103-507X.20170057

Oral histoplasmosis

Histoplasmose oral

Gustavo Antonio Correa Momesso, Tárik Ocon Braga Polo, Valthierre Nunes de Lima, Cecília Alves de Sousa, Ana Maria Pires Soubhia, Ellen Gaetti Jardim, Leonardo Perez Faverani

Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista “Julio de Mesquita Filho” - Araçatuba (SP), Brazil.
Division of Oral Patology, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista “Julio de Mesquita Filho” - Araçatuba (SP), Brazil.
Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul - Campo Grande (MS), Brazil.

Conflicts of interest: None.

Submitted on January 16, 2017
Accepted on February 03, 2017

Corresponding author: Ellen Cristina Gaetti Jardim, Faculdade de Odontologia da Universidade Federal de Mato Grosso do Sul, Cidade Universitária, Zip code: 79070-900 - Campo Grande (MS), Brazil, E-mail: ellen.jardim@ufms.br

 

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(1) and is frequently associated with AIDS.(2) Sometimes, histoplasmosis is misinterpreted with tuberculosis due to their clinical similarities.(3,4) Oral involvement is very rare in histoplasmosis, being associated only with its disseminated form.(5)

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.

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-positive patients, 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.

Gustavo Antonio Correa Momesso
Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.
Tárik Ocon Braga Polo
Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.
Valthierre Nunes de Lima
Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.
Cecília Alves de Sousa
Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.
Ana Maria Pires Soubhia
Division of Oral Patology, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.
Ellen Gaetti Jardim
Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul - Campo Grande (MS), Brazil.
Leonardo Perez Faverani
Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista "Julio de Mesquita Filho" - Araçatuba (SP), Brazil.

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