[Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient].
BACKGROUND
Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis.


METHODS
A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had a bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months.


CONCLUSIONS
This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this form but are rare in case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months.
Clyti
E
E
Service de Dermatologie, Centre Hospitalier Général de Cayenne.
Aznar
C
C
Couppie
P
P
Sainte-Marie
D
D
Lemoine
C
C
Huerre
M
M
Carme
B
B
Pradinaud
R
R
D000437:Alcoholism / Q000150:complications; D000935:Antifungal Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006660:Histoplasmosis / Q000175:diagnosis*; D006801:Humans; D007121:Immunocompetence; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000382:microbiology*; D012907:Smoking / Q000009:adverse effects; D014060:Tongue Diseases / Q000382:microbiology*; D014062:Tongue Neoplasms / Q000175:diagnosis; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis
D000935:Antifungal Agents; D017964:Itraconazole