Head and Neck Histoplasmosis—A Nightmare for Clinicians and Pathologists! Experience at a Tertiary Referral Cancer Centre

Abstract

Histoplasmosis is a rarely reported deep mycotic infection in the Indian context. Oral or oropharyngeal manifestation can occur as an isolated symptom or as part of a disseminated process associated with immunosuppression especially with HIV and diabetes. Five cases of head and neck histoplasmosis accrued over 6 years in a tertiary referral cancer institute were reviewed. All these patients presented clinically as cancer. In three patients, the marked pseudoepitheliomatous hyperplasia led to a mistaken biopsy diagnosis of malignancy following which definitive surgical treatment was performed. The subsequent excision revealed typical features of histoplasmosis. Isolated oral presentation of histoplasmosis can mimic malignancy both clinically as well as pathologically, leading to potentially disastrous consequences. A high index of suspicion in those with overt or hidden immunosuppression and a deep wedge biopsy to demonstrate the organisms in the subepithelial tissue is recommended.

Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

“…These clinical characteristics concur with the reported by other authors [11,18,28,30]. It is appropriate to refer that in 2 cases, oral manifestations…”

“…As in PCM, we also reported macrochelia in histoplasmosis. Mucocotaneous lesions of both mycoses can be observed in any oral structure and may be polymorphic [13,17,29,30]. For this reason, they can be misdiagnosed as tuberculosis, SCC, leishmaniasis, among others.…”

Disseminated histoplasmosis with oral and cutaneous manifestations

“…[23] Reported cases of histoplasmosis have been low in India with less than 50 cases being reported. [24]…”

Progressive disseminated histoplasmosis in an immunocompetent adult: A case report

“…Involvement of pharynx and larynx is rare. Lesions may notoriously mimic malignancy both clinically and pathologically and pose a great challenge for the clinicians in diagnosis and management (7). Many patients having oropharyngeal disease also have simultaneous involvement of adrenal glands which can present as life threatening adrenal insufficiency.…”