Oral histoplasmosis treated with miconazole

Area of Science:

• Oral pathology
• Mycology
• Infectious diseases

Background:

• Histoplasmosis typically affects the lungs but can manifest in other tissues.
• Gingival involvement is rare, especially without systemic or osseous spread.

Observation:

• A 50-year-old male presented with localized gingival lesions.
• Diagnosis confirmed via histology, fungal culture, and positive histoplasmin latex agglutination test.
• No osseous involvement or identifiable source of infection was found.

Findings:

• Initial treatment with intravenous amphotericin B caused severe side effects, including renal impairment and suppressed red blood cell production.
• Switching to intravenous miconazole resulted in effective lesion resolution, confirmed by repeat biopsy.
• The source of the fungal infection remained untraced.

Implications:

• This case highlights the importance of considering histoplasmosis in oral lesions, even without typical pulmonary symptoms.
• Intravenous miconazole can be an effective alternative treatment for localized gingival histoplasmosis when amphotericin B is contraindicated.
• Further research may be needed to identify potential non-pulmonary sources of Histoplasma capsulatum infection.