Oropharyngeal histoplasmosis: a report of 10 cases
Summary A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histop...
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| Veröffentlicht in: | Clinical and experimental dermatology 2019-07, Vol.44 (5), p.e181-e188 |
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| container_title | Clinical and experimental dermatology |
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| creator | Pincelli, T. Enzler, M. Davis, M. Tande, A. J. Comfere, N. Bruce, A. |
| description | Summary
A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains. |
| doi_str_mv | 10.1111/ced.13927 |
| format | Article |
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A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.</description><identifier>ISSN: 0307-6938</identifier><identifier>EISSN: 1365-2230</identifier><identifier>DOI: 10.1111/ced.13927</identifier><identifier>PMID: 30706506</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Amphotericin B ; Amphotericin B - therapeutic use ; Antifungal Agents - therapeutic use ; Azoles ; Biopsy ; Complement Fixation Tests ; Delayed Diagnosis ; Differential diagnosis ; Disseminated infection ; Female ; Histoplasmosis ; Histoplasmosis - diagnosis ; Histoplasmosis - drug therapy ; Histoplasmosis - immunology ; Histoplasmosis - pathology ; Humans ; Immunocompromised Host ; Infectious diseases ; Intravenous administration ; Male ; Middle Aged ; Mucosa ; Oropharynx - pathology ; Pain ; Pharyngeal Diseases - diagnosis ; Pharyngeal Diseases - drug therapy ; Pharyngeal Diseases - immunology ; Pharyngeal Diseases - pathology ; Pharynx ; Retrospective Studies ; Smoking ; Tongue - pathology ; Weight Loss</subject><ispartof>Clinical and experimental dermatology, 2019-07, Vol.44 (5), p.e181-e188</ispartof><rights>2019 British Association of Dermatologists</rights><rights>2019 British Association of Dermatologists.</rights><rights>Copyright © 2019 British Association of Dermatologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-a68f688a3ed711a15a87a58fbc1c004d80698d93fc2f1b708da486c6316242733</citedby><cites>FETCH-LOGICAL-c3537-a68f688a3ed711a15a87a58fbc1c004d80698d93fc2f1b708da486c6316242733</cites><orcidid>0000-0003-1722-5970</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30706506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pincelli, T.</creatorcontrib><creatorcontrib>Enzler, M.</creatorcontrib><creatorcontrib>Davis, M.</creatorcontrib><creatorcontrib>Tande, A. J.</creatorcontrib><creatorcontrib>Comfere, N.</creatorcontrib><creatorcontrib>Bruce, A.</creatorcontrib><title>Oropharyngeal histoplasmosis: a report of 10 cases</title><title>Clinical and experimental dermatology</title><addtitle>Clin Exp Dermatol</addtitle><description>Summary
A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amphotericin B</subject><subject>Amphotericin B - therapeutic use</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Azoles</subject><subject>Biopsy</subject><subject>Complement Fixation Tests</subject><subject>Delayed Diagnosis</subject><subject>Differential diagnosis</subject><subject>Disseminated infection</subject><subject>Female</subject><subject>Histoplasmosis</subject><subject>Histoplasmosis - diagnosis</subject><subject>Histoplasmosis - drug therapy</subject><subject>Histoplasmosis - immunology</subject><subject>Histoplasmosis - pathology</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Infectious diseases</subject><subject>Intravenous administration</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mucosa</subject><subject>Oropharynx - pathology</subject><subject>Pain</subject><subject>Pharyngeal Diseases - diagnosis</subject><subject>Pharyngeal Diseases - drug therapy</subject><subject>Pharyngeal Diseases - immunology</subject><subject>Pharyngeal Diseases - pathology</subject><subject>Pharynx</subject><subject>Retrospective Studies</subject><subject>Smoking</subject><subject>Tongue - pathology</subject><subject>Weight Loss</subject><issn>0307-6938</issn><issn>1365-2230</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LAzEQhoMotlYP_gFZ8KKHbTPJ5mO9lVo_oNCLnkOazdotu82adJH-e6PbXgTnMvDy8DLzIHQNeAxxJsYWY6A5ESdoCJSzlBCKT9EQUyxSnlM5QBchbDAGCoKdo0HMMWeYDxFZeteutd9vP6yuk3UVdq6tdWhcqMJDohNvW-d3iSsTwInRwYZLdFbqOtirwx6h96f52-wlXSyfX2fTRWoooyLVXJZcSk1tIQA0MC2FZrJcGTAYZ4XEPJdFTktDSlgJLAudSW44BU4yIigdobu-t_Xus7Nhp5oqGFvXemtdFxQBkTMgwFlEb_-gG9f5bbxORRU5YMqyPFL3PWW8C8HbUrW-auLvCrD6EamiSPUrMrI3h8Zu1cT0SB7NRWDSA19Vbff_N6nZ_LGv_AaDRnks</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Pincelli, T.</creator><creator>Enzler, M.</creator><creator>Davis, M.</creator><creator>Tande, A. J.</creator><creator>Comfere, N.</creator><creator>Bruce, A.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1722-5970</orcidid></search><sort><creationdate>201907</creationdate><title>Oropharyngeal histoplasmosis: a report of 10 cases</title><author>Pincelli, T. ; Enzler, M. ; Davis, M. ; Tande, A. J. ; Comfere, N. ; Bruce, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-a68f688a3ed711a15a87a58fbc1c004d80698d93fc2f1b708da486c6316242733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amphotericin B</topic><topic>Amphotericin B - therapeutic use</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Azoles</topic><topic>Biopsy</topic><topic>Complement Fixation Tests</topic><topic>Delayed Diagnosis</topic><topic>Differential diagnosis</topic><topic>Disseminated infection</topic><topic>Female</topic><topic>Histoplasmosis</topic><topic>Histoplasmosis - diagnosis</topic><topic>Histoplasmosis - drug therapy</topic><topic>Histoplasmosis - immunology</topic><topic>Histoplasmosis - pathology</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>Infectious diseases</topic><topic>Intravenous administration</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mucosa</topic><topic>Oropharynx - pathology</topic><topic>Pain</topic><topic>Pharyngeal Diseases - diagnosis</topic><topic>Pharyngeal Diseases - drug therapy</topic><topic>Pharyngeal Diseases - immunology</topic><topic>Pharyngeal Diseases - pathology</topic><topic>Pharynx</topic><topic>Retrospective Studies</topic><topic>Smoking</topic><topic>Tongue - pathology</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pincelli, T.</creatorcontrib><creatorcontrib>Enzler, M.</creatorcontrib><creatorcontrib>Davis, M.</creatorcontrib><creatorcontrib>Tande, A. J.</creatorcontrib><creatorcontrib>Comfere, N.</creatorcontrib><creatorcontrib>Bruce, A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical and experimental dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pincelli, T.</au><au>Enzler, M.</au><au>Davis, M.</au><au>Tande, A. J.</au><au>Comfere, N.</au><au>Bruce, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oropharyngeal histoplasmosis: a report of 10 cases</atitle><jtitle>Clinical and experimental dermatology</jtitle><addtitle>Clin Exp Dermatol</addtitle><date>2019-07</date><risdate>2019</risdate><volume>44</volume><issue>5</issue><spage>e181</spage><epage>e188</epage><pages>e181-e188</pages><issn>0307-6938</issn><eissn>1365-2230</eissn><abstract>Summary
A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30706506</pmid><doi>10.1111/ced.13927</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1722-5970</orcidid></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Amphotericin B Amphotericin B - therapeutic use Antifungal Agents - therapeutic use Azoles Biopsy Complement Fixation Tests Delayed Diagnosis Differential diagnosis Disseminated infection Female Histoplasmosis Histoplasmosis - diagnosis Histoplasmosis - drug therapy Histoplasmosis - immunology Histoplasmosis - pathology Humans Immunocompromised Host Infectious diseases Intravenous administration Male Middle Aged Mucosa Oropharynx - pathology Pain Pharyngeal Diseases - diagnosis Pharyngeal Diseases - drug therapy Pharyngeal Diseases - immunology Pharyngeal Diseases - pathology Pharynx Retrospective Studies Smoking Tongue - pathology Weight Loss |
| title | Oropharyngeal histoplasmosis: a report of 10 cases |
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