Oral histoplasmosis: an unusual presentation.
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-alpha) 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.


RESULTS
This article describes an unusual presentation of oral histoplasmosis in a 75-year-old-woman patient on TNF-alpha 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.


CONCLUSIONS
This is the first reported case, insofar as the authors are able to determine, of oral histoplasmosis, in a patient undergoing treatment with infliximab.
Narayana
Nagamani
N
Department of Oral Biology, UNMC College of Dentistry, 40th and Holdrege streets, Lincoln, Nebraska 68583, USA. nnarayana@unmc.edu
Gifford
Ryan
R
Giannini
Peter
P
Casey
John
J
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006660:Histoplasmosis / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D009059:Mouth Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*
D000935:Antifungal Agents; D017964:Itraconazole