Treating oral histoplasmosis in an immunocompetent patient.

BACKGROUND: Histoplasmosis is a deep fungus infection that occurs worldwide and is caused by Histoplasma capsulatum. Oral histoplasmosis has been of considerable importance in recent years because it occurs frequently in immunosuppressed patients, more often in those who test positive for the human immunodeficiency virus (HIV). However, the literature contains reports of histoplasmosis in immunocompetent patients, especially in endemic areas.

CASE DESCRIPTION: The authors describe a case of an HIV-negative, immunocompetent 60-year-old man with ulcerative and painful oral lesions. The clinician included squamous cell carcinoma and systemic mycosis in the differential diagnosis. After the patient underwent a biopsy and a definitive diagnosis was reached, his initial treatment regimen included itraconazole (200 milligrams per day for one month), nystatin and chlorhexidine mouthrinse (0.12 percent, 10 milliliters, two times a day). The itraconazole treatment was continued for three more months (100 mg daily) until the lesions had resolved completely.

CLINICAL IMPLICATIONS: Clinicians need to conduct a careful clinical evaluation and make an accurate diagnosis of ulcerated oral lesions. Knowledge of the oral manifestations of histoplasmosis may enable clinicians to reach a diagnosis earlier and initiate therapy more quickly.