Head and neck involvement with histoplasmosis; the great masquerader
Author links open overlay panelA.SinghaM.GauriaP.GautamaD.GautambM.HaqaA.C.HandaaK.K.Handaa
a
Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- The Medicity, Gurugram, Haryana, India
b
Department of Pathology, Medanta- The Medicity, Gurugram, Haryana, India
Received 7 March 2019, Available online 3 June 2019.
https://doi.org/10.1016/j.amjoto.2019.06.002Get rights and content
Abstract
Introduction
Head and neck involvement with histoplasmosis usually occurs as a part of the disseminated illness. There are no pathognomic features of the upper aerodigestive tract involvement and the lesion may mimic a host of other conditions. The current report presents our experience with head and neck histoplasmosis in a non-endemic tertiary care center.
Materials and methods
We present a case of disseminated histoplasmosis with oral symptoms and lesions as the chief complaints. A 10 years' retrospective institutional database search was undertaken to identify the patients with histoplasmosis affecting head and neck region treated at our institution. The demographic and treatment details of the patients were reviewed.
Results
In addition to the index patient, four more patients (two with gingivobuccal and one each with nasal and laryngeal histoplasmosis) were found. Out of the five patients, only one patient was found to have underlying immunosuppression. All of the patients were diagnosed with biopsy showing typical appearance of the intracellular organism. All the patients were satisfactorily treated with systemic antifungal treatment.
Conclusion
Upper aerodigestive tract involvement with histoplasmosis can present as an intriguing clinical puzzle. A high index of suspicion is needed and biopsy is the gold standard for the diagnosis. Intravenous Liposomal Amphotericin B and oral Itraconazole are standard treatment agents of choice and are highly efficacious in achieving cure.
Keywords
HistoplasmosisOtolaryngologyImmunity, cellularRetrospective studiesAntifungal agents
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© 2019 Elsevier Inc. All rights reserved.
Author links open overlay panelA.SinghaM.GauriaP.GautamaD.GautambM.HaqaA.C.HandaaK.K.Handaa
a
Department of Otorhinolaryngology and Head and Neck Surgery, Medanta- The Medicity, Gurugram, Haryana, India
b
Department of Pathology, Medanta- The Medicity, Gurugram, Haryana, India
Received 7 March 2019, Available online 3 June 2019.
https://doi.org/10.1016/j.amjoto.2019.06.002Get rights and content
Abstract
Introduction
Head and neck involvement with histoplasmosis usually occurs as a part of the disseminated illness. There are no pathognomic features of the upper aerodigestive tract involvement and the lesion may mimic a host of other conditions. The current report presents our experience with head and neck histoplasmosis in a non-endemic tertiary care center.
Materials and methods
We present a case of disseminated histoplasmosis with oral symptoms and lesions as the chief complaints. A 10 years' retrospective institutional database search was undertaken to identify the patients with histoplasmosis affecting head and neck region treated at our institution. The demographic and treatment details of the patients were reviewed.
Results
In addition to the index patient, four more patients (two with gingivobuccal and one each with nasal and laryngeal histoplasmosis) were found. Out of the five patients, only one patient was found to have underlying immunosuppression. All of the patients were diagnosed with biopsy showing typical appearance of the intracellular organism. All the patients were satisfactorily treated with systemic antifungal treatment.
Conclusion
Upper aerodigestive tract involvement with histoplasmosis can present as an intriguing clinical puzzle. A high index of suspicion is needed and biopsy is the gold standard for the diagnosis. Intravenous Liposomal Amphotericin B and oral Itraconazole are standard treatment agents of choice and are highly efficacious in achieving cure.
Keywords
HistoplasmosisOtolaryngologyImmunity, cellularRetrospective studiesAntifungal agents
View full text
© 2019 Elsevier Inc. All rights reserved.
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