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Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens
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Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens

Published on: February 14, 2011

Oral histoplasmosis: an unusual presentation

Nagamani Narayana1, Ryan Gifford, Peter Giannini

  • 1Department of Oral Biology, UNMC College of Dentistry, 40th and Holdrege streets, Lincoln, Nebraska 68583, USA. nnarayana@unmc.edu

Head & Neck
|September 18, 2008
PubMed
Abstract

Insights

This case study reports the first instance of oral histoplasmosis in a patient using infliximab, a TNF-alpha antagonist. Treatment with itraconazole was successful, highlighting a rare complication of immunosuppressive therapy.

Area of Science:

  • Mycology
  • Immunology
  • Gastroenterology

Background:

  • Histoplasmosis is a fungal infection that can reactivate in immunosuppressed individuals.
  • Tumor necrosis factor alpha (TNF-alpha) antagonists, used for autoimmune conditions, are associated with histoplasmosis reactivation.
  • Granuloma formation is often suppressed in TNF-alpha antagonist-associated histoplasmosis.

Observation:

  • A 75-year-old woman on infliximab presented with an unusual oral histoplasmosis.
  • Microscopic examination revealed cellular atypia, prompting a lymphoma work-up.
  • Gomori's methenamine silver stain confirmed Histoplasma capsulatum.

Findings:

  • The patient was diagnosed with oral histoplasmosis.
  • The condition was successfully treated with itraconazole.
  • This represents the first reported case of oral histoplasmosis in an infliximab patient.

Implications:

  • Highlights a rare oral manifestation of histoplasmosis in patients on TNF-alpha antagonists.
  • Underscores the importance of considering opportunistic infections in immunosuppressed patients.
  • Suggests careful monitoring for atypical presentations in patients receiving TNF-alpha inhibitors.

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