Oropharyngeal histoplasmosis: The diagnosis lies in the biopsy

Area of Science:

• Mycology
• Infectious Diseases
• Oral Pathology

Background:

• Histoplasma capsulatum is a dimorphic fungus endemic to specific regions worldwide.
• Infection can range from asymptomatic to acute pulmonary disease, with chronic forms affecting elderly males.
• Oropharyngeal histoplasmosis can mimic other conditions, such as squamous cell carcinoma.

Purpose of the Study:

• To report a case of oropharyngeal histoplasmosis in an elderly male presenting with chronic oral lesions.
• To emphasize the diagnostic challenges posed by negative serological and antigen tests.
• To highlight the indispensable role of tissue biopsy in diagnosing oral histoplasmosis.

Main Methods:

• Case presentation of a 79-year-old male with progressive oral lesions, odynophagia, and weight loss.
• Initial suspicion of oropharyngeal squamous cell carcinoma.
• Diagnosis confirmed via oral biopsy and histopathological examination.

Main Results:

• Histoplasma urine antigen, serum complement fixation antibody titers, and fungal tissue stains were negative.
• Oral biopsy was essential for establishing the diagnosis of histoplasmosis.
• The patient presented with symptoms mimicking malignancy.

Conclusions:

• Oropharyngeal histoplasmosis can present insidiously, particularly in elderly males.
• Standard diagnostic tests for Histoplasma capsulatum may yield false-negative results.
• Tissue biopsy remains a critical tool for definitive diagnosis of oropharyngeal histoplasmosis.