Primary localized histoplasmosis with lesions restricted to the mouth in a Chinese HIV-negative patient

Abstract

Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which is endemic in many areas of the world but is relatively rare in China. Although the majority of cases present as a mild to moderate flu-like disease requiring only supportive therapy, approximately 1% of patients experience more serious pulmonary and extrapulmonary disease, which can be life-threatening if diagnosis is delayed or the treatment is not initiated rapidly. Definitive diagnosis is usually made by a combination of culture, detection of the organism in tissues, measurement of antibodies, and detection of antigen. We present the case of a 51-year-old patient who presented with histoplasmosis only, with several ulcerated lesions in the oral cavity and without HIV infection, who did not show any detectable signs and symptoms of systemic disease or extra-oral manifestations. Histopathological analysis indicated a chronic inflammatory process with granulomas with yeast-like organisms. Isolation of H. capsulatum and molecular identification provided the definitive diagnosis. Treatment with oral itraconazole led to remission of the oral lesions. This is the first Chinese case report of localized histoplasmosis with lesions restricted to the mouth in an HIV-negative patient.

Histoplasmosis: a new endemic fungal infection in China? Review and analysis of cases

“…Histoplasma capsulatum was only isolated in culture from 68 patients. Six isolates were further confirmed by molecular analyses 5,6,9–11,18 . One isolate from bone marrow of a disseminated infection patient, who had no history of travelling, was identified as H. capsulatum var.…”

“…In a survey of histoplasmin skin‐tests reactivity, 735 Chinese volunteers with no history of living abroad were tested; 8.9% and 15.1% of the healthy volunteers from the Hunan and Jiangsu provinces, respectively, tested positive, yet only 2.1% were positive in the relatively arid Wulumuqi, Xinjiang province 4 . With the improved access to diagnostic laboratories in recent years, an increasing number of cases of histoplasmosis have been identified 5,6 . However, information from these patients was often reported in case studies, most of which were written in Chinese.…”

A gingival manifestation of histoplasmosis leading diagnosis

“…[5710] On the other hand, disseminated histoplasmosis has been reported in immunocompetent patients like the present one, representing a lifelong chronic condition which can erupt in active disease if the host–pathogen balance is disrupted. [91112] We have not identified any source of immunodeficiency in our patient.…”

Detection and Phylogenetic Characterization of a Case of Histoplasma capsulatum Infection in Mainland China

“…1 However, sporadic cases of autochthonous histoplasmosis have been encountered in China, which was traditionally considered nonendemic for H. capsulatum. [2][3][4] Recently, a multilocus sequence typing (MLST) approach and a sequence database were available for H. capsulatum, which helped us to better understand the molecular epidemiology of this disease. 5 Here, we reported a case of disseminated histoplasmosis in an human immunodeficiency virus (HIV)-negative patient who had never been outside China.…”