Head and neck involvement with histoplasmosis; the great masquerader

Area of Science:

• Infectious Diseases
• Mycology
• Otolaryngology

Background:

• Head and neck histoplasmosis often presents as part of disseminated disease.
• Lesions in the upper aerodigestive tract lack specific features and can mimic various conditions.
• This study reports on head and neck histoplasmosis cases managed at a non-endemic tertiary care center.

Observation:

• A case of disseminated histoplasmosis with primary oral symptoms was identified.
• A 10-year retrospective review identified four additional patients with head and neck histoplasmosis.
• The majority of patients (4/5) were immunocompetent.

Findings:

• Histoplasmosis affected the gingivobuccal region (2), nasal cavity (1), and larynx (1).
• Diagnosis was confirmed via biopsy, revealing the characteristic intracellular organism.
• All patients responded well to systemic antifungal therapy.

Implications:

• Head and neck histoplasmosis presents a diagnostic challenge requiring a high index of suspicion.
• Biopsy is the definitive diagnostic method.
• Effective treatment options include Intravenous Liposomal Amphotericin B and oral Itraconazole, leading to successful patient outcomes.