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Oral histoplasmosis: a case report

G E Mead1, D Wilks, K McLaren

  • 1Royal Victoria Hospital, Edinburgh, UK.

The Journal of Infection
|November 20, 1998
PubMed
Summary

A rare case of histoplasmosis reactivated after 50 years in an 81-year-old man with mouth ulcers is presented. This long-term latent infection was triggered by congestive cardiac failure and corticosteroid use.

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Area of Science:

  • Infectious Diseases
  • Immunology
  • Tropical Medicine

Background:

  • Histoplasmosis is a fungal infection typically caused by Histoplasma capsulatum.
  • Reactivation of latent infections can occur, particularly in immunocompromised individuals.
  • Long latent periods of fungal infections are uncommon but documented.

Observation:

  • An 81-year-old male presented with biopsy-proven histoplasmosis manifesting as mouth ulcers.
  • The patient had a probable initial exposure during World War II as a prisoner of war in Sumatra.
  • The infection reactivated during an episode of congestive cardiac failure and treatment with oral corticosteroids for idiopathic thrombocytopaenic purpura.

Findings:

  • A remarkable latent period of 50 years was observed between initial exposure and reactivation.
  • The case is notable for a positive cytoplasmic antineutrophil cytoplasmic antibody (cANCA) titre.
  • Histoplasmosis reactivation was confirmed via biopsy.

Implications:

  • This case highlights the potential for extremely long latent periods in Histoplasma infections.
  • It underscores the importance of considering latent infections in immunocompromised patients with unusual presentations.
  • The positive cANCA titre in this context warrants further investigation into its diagnostic or prognostic significance.

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