Oral ulcerative lesions in a post-liver-transplantation patient

• Published in: Autopsy & case reports 2019-01, Vol.9 (1), p.e2018046
• Main Authors: Nakamura, Gabriele Prospero, Moraes, Renata Mendonça, Siqueira, Juliana Mota, de Oliveira, Andrea Cruz Ferraz, Begnami, Maria Dirlei Ferreira de Souza, Jaguar, Graziella Chagas
• Format: Article
• Language: English
• Subjects: Clinical Case Reports; Histoplasmosis; Immunosuppression; Liver Transplantation; Oral ulcer
• ISSN: 2236-1960; 2236-1960
• DOI: 10.4322/acr.2018.046

Oral involvement is rarely found in histoplasmosis, except in its disseminated form, which is mostly observed in the severely immunocompromised host. Herein, we presented the case of a 36-year-old female with a previous history of liver transplant, who was hospitalized due to fever, chills, night sweats, diarrhea, and painful oral lesions over the last 3 days. The oral examination revealed the presence of painful shallow ulcers lined by a pseudomembrane in the gingiva and the soft and hard palate. The initial working diagnosis comprised cytomegalovirus reactivation or herpes simplex virus infection. The diagnostic work-up included incisional biopsies of the gingiva and the sigmoid colon. Both biopsies confirmed the diagnosis of histoplasmosis. Intravenous itraconazole was administered with significant improvement after 7 days. Although oral involvement is rare, histoplasmosis should be included in the differential diagnosis of oral lesions, particularly when the patient is immunosuppressed. This study reports a rare presentation of histoplasmosis involving the mucosa of the oral cavity and the colon.