Dogenski Letícia Copatti, Pasqualotto Eduarda Mafaciolli, Dutra Mateus José, Rovani Gisele, Trentin Micheline Sandini, De Carli João Paulo
Postgraduate Program in Oral Diagnosis, School of Dentistry of the Federal University of Santa Catarina, Florianópolis, SC, Brazil.
School of Dentistry of the University of Passo Fundo, Passo Fundo, RS, Brazil.
Int J Surg Case Rep. 2022 Apr;93:106920. doi: 10.1016/j.ijscr.2022.106920. Epub 2022 Mar 9.
Histoplasmosis is a systemic fungal disease caused by the H. capsulatum fungus, which is mainly present in feces and guano of birds and bats. This condition manifests in several ways and it is more severe in its disseminated form and in immunosuppressed patients, putting the patient at risk of death if not diagnosed in time.
This report presents the case of a 39-year-old white female patient, a seller of agricultural machinery, with a history of lupus erythematosus, who attended a private dental office complaining of a tongue lesion. The patient reported having been subjected to an incisional biopsy of this lesion and the histopathological examination identified an inflammatory process. Considering the inefficient management of the lesion with intralesional application of corticosteroids, squamous cell carcinoma or granulomatous fungal infection was suspected, and a new biopsy was performed allowing the diagnosis of histoplasmosis already spread to the liver, intestines, and bone marrow. The diagnosed disease led the patient to undergo extensive antifungal treatment, including a period of hospitalization.
The diagnosis of histoplasmosis can be delayed due to several factors, mainly due to its diverse clinical presentation between acute, chronic and disseminated forms. However, achieving an early diagnosis for histoplasmosis is very important to maintain the patient's quality of life.
Greater education, information, and awareness about histoplasmosis among health professionals are required for managing these cases, especially in endemic areas to H. capsulatum.
组织胞浆菌病是一种由荚膜组织胞浆菌引起的全身性真菌疾病，该真菌主要存在于鸟类和蝙蝠的粪便及排泄物中。这种疾病有多种表现形式，其播散型及免疫抑制患者病情更为严重，若不及时诊断，患者有死亡风险。
本报告介绍了一名39岁的白人女性患者，她是一名农业机械销售人员，有红斑狼疮病史，因舌部病变前往一家私人牙科诊所就诊。患者报告曾对该病变进行切开活检，组织病理学检查发现有炎症过程。鉴于病灶内注射皮质类固醇对病变治疗效果不佳，怀疑为鳞状细胞癌或肉芽肿性真菌感染，遂再次进行活检，确诊为已扩散至肝脏、肠道和骨髓的组织胞浆菌病。确诊疾病后，患者接受了广泛的抗真菌治疗，包括一段时间的住院治疗。
组织胞浆菌病的诊断可能因多种因素而延迟，主要是由于其在急性、慢性和播散型之间临床表现多样。然而，早期诊断组织胞浆菌病对于维持患者的生活质量非常重要。
对于这些病例的管理，尤其是在荚膜组织胞浆菌流行地区，卫生专业人员需要加强对组织胞浆菌病的教育、信息传播和认识。
