The authors report a clinical case of an isolated oral histoplasmosis in a hemodialysis patient that presented with fever of unknown origin and had an unremarkable physical examination. During the investigation, a Gallium scan showed uptake in the oral cavity and soon after the oral cavity examination revealed a granulomatous lesion on the tooth 26. Histopathologic findings were compatible with histoplasmosis. The treatment regimen included liposomal amphotericin B followed by itraconazole consolidation therapy, and side effects did not occur. Both clinical evolution and outcome were favorable. Oral histoplasmosis in a non-immunosuppressed patient is extremely rare.

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Introduction:Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods:Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period . Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

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Syphilis is a systemic disease caused by the transmission through sexual contact of Treponema pallidum. It has a high incidence in men who have sex with other men, and is associated with human immunodeficiency virus (HIV) infection. The diagnosis depends on serological tests or confirmation of the spirochete in histological samples. The primary lesion courses after a latency period of 2 to 6 weeks, and the secondary disseminated phase, usually associated with mucocutaneous lesions and lymphadenopathy, may involve any organ. Symptomatic syphilitic hepatitis is a rare manifestation, the diagnosis of which is a challenge. It is characterized by a marked elevation of alkaline phosphatase, moderate elevation of transaminases, and no bilirubin changes. Histologically, portal inflammation and non-caseous granulomas predominate without associated necrosis. The case described is a rare manifestation of secondary syphilis, in the form of hepatitis in a sexually active HIV-infected patient with good response to the recommended benzathine penicillin treatment.