title: Epiglottic histoplasmosis presenting in a nonendemic region: a clinical mimic of laryngeal carcinoma.
abstract: Histoplasma capsulatum is a dimorphic fungus endemic to North America. Histoplasmosis is primarily an inhalation-acquired mycosis that is encountered rarely outside of endemic regions. In nonendemic regions, histoplasmosis may present a diagnostic challenge and both clinical and laboratory vigilance are required to accurately identify infection. Unusual clinical presentations with limited physical findings may compound the difficulty in diagnosis. We describe a 78-year-old retired soil science professor who presented with an eroded epiglottic mass secondary to disseminated histoplasmosis in a nonendemic region (Alberta). Clinically, this mass was thought to represent a primary laryngeal carcinoma, as no other buccal or oropharyngeal ulcers were identified. Histoplasmosis was confirmed by tissue biopsy and a positive immunodiffusion test for immunoglobulin G. Disseminated histoplasmosis is often associated with laryngeal and oropharyngeal disease; however, isolated epiglottic histoplasmosis is rare. Histoplasmosis should be included in the differential diagnosis of neoplasms and chronic ulcers of the upper aerodigestive tract.
authors.affiliation: Dynacare Kasper Medical Laboratories and the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada. cohara@ualberta.ca
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: O'Hara
authors.forename: Michael W
authors.initials: MW
authors.lastname: Allegretto
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Taylor
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Isotalo
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D002277:Carcinoma / Q000175:diagnosis; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D004825:Epiglottis / Q000473:pathology; D006660:Histoplasmosis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis; D008297:Male