Page 19 - GP Spring 2018

for treatment. This was followed up with eas have serologic evidence of having had References
phone calls to the patient’s family. The pa- the disease. Histoplasmosis is found more 1. Hernandez SL, Lopez de Blanc SA, Sambuel-

tient’s daughter stated that a systemic reg- prevalently in third world countries and in li RH, Roland H, Cornelli C, Lattanzi V, Car-
imen of the antifungal drug Amphotericin patients with suppressed immunity, such as nelli MA. Oral histoplasmosis associated HIV
infection: a comparative study. J Oral Pathol
B had a satisfactory outcome in treatment from AIDS. In fact, based on a comparative Med. 2004 (33): 445-50.
of the lesion. The patient has since returned study of HIV+ and HIV- patients, it can be 2. Patil K, Mahima VG, Prathiba RM. Oral His-
to his home country of Haiti and is lost to inferred that if histoplasmosis is diagnosed toplasmosis. J Indian Society Periodontol. 2009
further follow-up. in a young patient, then a search for HIV is 13(3): 157-59.
justified. 1 3. Kauffman, Carol MD. Histoplasmosis. Clin
Discussion Chest Med 2009 (30): 217-225.
The initial clinical diagnosis was a den- Treatment of the disease is dependent on 4. Rahman MT, Bakar NHA, Philip R, Shamsu-
din AR. Oral Histoplasmosis presenting as oral
ture-associated traumatic ulcer or lesion the health status of the individual. Healthy ulcer in a non-HIV patient. Southeast Asian J
4
such as a traumatized epulis fissuratum. individuals with acute pulmonary histo- Trop Med Public Health. 2004 35 (2): 388-390.
Epulis fissuratum is a reactive inflamma- plasmosis may experience flu like symp-
tory fibrous hyperplasia caused by the toms. Most individuals recover sponta-
chronic irritation of the flange area of the neously within three weeks after exposure.
denture. There is usually an isolated area Antifungal treatment may not always be
with two folds of hyperplastic tissue on ei- initiated in healthy individuals unless the Dr. David Levenson is
ther side of a linear ulcer. The tissue is usu- disease persists longer or disseminates, as a graduate of New York
ally pink and fibrous. In the present case, in the case presented. The standard treat- University College of
there was an ulcerated area with hyperplas- ment is Amphotericin B or the systemic Dentistry and also has
tic folds of tissue. However, the ulceration azoles (itraconazole or ketoconazole). Am- a Master of Science De-
appeared more widespread, extending from photericin B is the drug of choice in severe gree in Histology from
the central alveolar ridge posteriorly to the cases and immunosuppressed patients. 2,4 NYUCD. He is a full-time
mucobuccal fold. The lesion also appeared Clinical Assistant Professor at NYUCD,
to be more leukoplakic. Consequently, Oral infection is rare and usually pres- teaching in the Dept. of Oral and Maxil-
traumatic ulcer and epulis fissuratum were ents as a secondary lesion of disseminated lofacial, Pathology, Radiology, & Med-
excluded and the revised differential diag- disease. About 30-60% of patients with icine. Dr. Levenson also has a general
nosis included SCC, other malignancy such disseminated histoplasmosis have oral le- dental practice in Queens, N.Y. He can
as lymphoma, or deep fungal infection. The sions. It is rarely noted in immunocompe- be reached at e-mail: dal11@nyu.edu.
4
ulcers formed by SCC are usually leuko- tent patients. However, it can occur as an
plakic, red, or mixed with keratotic bor- isolated lesion in the mouth and the route of Dr. Sonal S. Shah is a
ders. Ulcers caused by histoplasmosis may occurrence may be from direct inoculation full-time clinical assis-
be clinically similar or granulomatous with of the fungus into the mucosa. The patient tant professor at New
1
raised borders. 2 in this case report did not have any signs of York University Col-
pulmonary or systemic histoplasmosis. He lege of Dentistry. She
Considering the length of time the lesion was not immunocompromised and it is not attended college and
was present and its clinical appearance, bi- known if he had traveled outside of New dental school in Texas
opsy of the lesion was the logical choice. York City within recent months. Unfortu- and then moved to New York to com-
Fortunately, the lesion turned out to be a nately, it is unclear how he contracted the plete her oral and maxillofacial pathol-
histoplasmosis fungal infection, easily disease. ogy residency. She is a board-certified
treatable with antifungal medications, rath- oral pathologist. She is the director of
er than the more dreaded squamous cell Conclusions the NYU Oral Medicine Clinic and also
carcinoma. 1. In conclusion, this case report teaches has a private practice in Manhattan. Dr.
the general dentist the importance of Shah holds several leadership positions
The fungus Histoplasma capsulatum is following the two-week rule in treat- in national professional societies such
found throughout the world. It is endemic ing patients with pathology. Any sore as ADEA, American Academy of Oral
in certain areas of the U.S., especially in in the oral cavity that does not heal Medicine and the American Academy of
the Mississippi and Ohio River valleys. within two weeks should be further Oral Pathology.
Bird and bat droppings in soil promote evaluated.
growth of the fungus. Human infection 2. Information gathered from a thorough
3,4
commonly occurs after inhalation of spores medical, social, and dental history is
generated from disturbance of the soil. His- important in arriving at a correct di-
toplasmosis mostly affects the lungs, but agnosis. The fact that the patient indi-
can occasionally disseminate throughout cated many months of denture adjust-
the body and oral cavity. 1,3 ments, coupled with the fact that he
was a smoker, led the dental team to
The severity of the disease is determined by look beyond a simple denture sore.
the number of conidia that are inhaled and 3. Follow up of the patient is an import-
the immune response of the host. In most ant part of the treatment. It aids in

cases, primary infection is mild. It is inter- convincing the patient the importance
4
esting to note that, although there are so few of treatment and it shows a caring atti-
cases, 30% of people living in endemic ar- tude on the part of the dentist.
www.nysagd.org l Spring 2018 l GP 19