Brazão-Silva Marco Tullio, Mancusi Grabriela Wagner, Bazzoun Francine Vilar, Ishisaki Gleyce Yakushijin, Marcucci Marcelo
Department of Stomatology, Heliopolis Hospital, São Paulo, SP, Brazil.
Contemp Clin Dent. 2013 Jan;4(1):97-101. doi: 10.4103/0976-237X.111621.
Histoplasmosis is a world-wide distributed deep mycosis caused by Histoplasma capsulatum which has been endemic in many countries. We present a case involving an immunocompetent man evidencing the necessity of a multidisciplinary approach and rational requisition of exams. The disease has started as a pulmonary disease mimicking tuberculosis, although the exams have been negative. Immunodiffusion test indicate histoplasmosis, not confirmed by culture of sputum. After days the patient was forwarded by a private doctor for evaluation of oral lesions at our Department of Stomatology. An incisional biopsy revealed a nonspecific granulomatous inflammation and the Grocott-Gomori methenamine silver stain identified scarce oval structures that could represent fungal yeast. Sampling oral lesions with swab, it was observed the typical growth of H. capsulatum on culture. This case highlights the importance of doctor's integration diagnosing histoplasmosis, while a wide spectrum of clinical manifestations should be expected. Oral lesions may be the critical manifestation leading diagnosis.
组织胞浆菌病是一种由荚膜组织胞浆菌引起的全球分布的深部真菌病，该病在许多国家呈地方性流行。我们报告一例涉及免疫功能正常男性的病例，证明了多学科方法和合理检查要求的必要性。该疾病最初表现为类似肺结核的肺部疾病，尽管检查结果为阴性。免疫扩散试验提示为组织胞浆菌病，但痰培养未证实。几天后，一名私人医生将该患者转至我们口腔医学科评估口腔病变。切开活检显示非特异性肉芽肿性炎症，格罗科特-戈莫里六胺银染色发现了稀少的椭圆形结构，可能代表真菌酵母。用拭子对口腔病变进行采样，在培养物中观察到荚膜组织胞浆菌的典型生长。该病例强调了医生综合诊断组织胞浆菌病的重要性，同时应预期到广泛的临床表现。口腔病变可能是导致诊断的关键表现。
