Oral histoplasmosis: An unusual presentation

Nagamani Narayana, Ryan Gifford, Peter J Giannini, John Casey

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Histoplasmosis is a localized or systemic fungal infection which may present as an acute primary or "reactivation" infection in the setting of immunosuppression. Tumor necrosis factor alpha (TNF-α) antagonists, used in the management of rheumatoid arthritis and Crohn disease, have been linked to reactivation of quiescent histoplasmosis. Microscopically, granulomas are either not evident or are infrequent in histoplasmosis when associated with TNF antagonist therapy presumably due to the suppression of macrophage activity. Methods and Results. This article describes an unusual presentation of oral histoplasmosis in a 75-year-old-woman patient on TNF-α antagonist, namely infliximab. Microscopically, cellular atypia resulted in a work-up to rule out lymphoma. Gomori's methenamine silver stain demonstrated Histoplasma capsulatum leading to a diagnosis of histoplasmosis. She was treated successfully with itraconozole. Conclusion. This is the first reported case, insofar as the authors are able to determine, of oral histoplasmosis, in a patient undergoing treatment with infliximab.

Original languageEnglish (US)
Pages (from-to)274-277
Number of pages4
JournalHead and Neck
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2009

Fingerprint

Histoplasmosis
Tumor Necrosis Factor-alpha
Methenamine
Histoplasma
Mycoses
Granuloma
Crohn Disease
Immunosuppression
Lymphoma
Rheumatoid Arthritis
Coloring Agents
Macrophages
Therapeutics
Infection

Keywords

  • Atypical lymphocytic proliferation
  • Immunosuppressive medications
  • Infliximab
  • Oral histoplasmosis
  • TNF-alpha antagonists

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Oral histoplasmosis : An unusual presentation. / Narayana, Nagamani; Gifford, Ryan; Giannini, Peter J; Casey, John.

In: Head and Neck, Vol. 31, No. 2, 01.02.2009, p. 274-277.

Research output: Contribution to journalArticle

Narayana, Nagamani ; Gifford, Ryan ; Giannini, Peter J ; Casey, John. / Oral histoplasmosis : An unusual presentation. In: Head and Neck. 2009 ; Vol. 31, No. 2. pp. 274-277.
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