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• W2914228045 abstract "Introduction: Histoplasmosis is an endemic fungal infection caused by inhalation of microconidia of Histoplasma capsulatum, a dimorphic fungus. It generally presents as acute or chronic pulmonary infection; disseminated histoplasmosis (DH); and mediastinal fibrosis. Here we present an unusual case of histoplasmosis presenting as a non-healing tongue ulcer along with bilateral adrenal gland involvement in a cirrhotic patient. Case: 59 yr old male with a past medical history of cirrhosis and type 2 diabetes mellitus presented with a tongue ulcer associated with intermittent dry cough and fever since 1 year. At admission, he had normal vitals and on physical examination, a large tongue ulcer on the right lateral border (4x5cm) with granulation tissue and smooth margins was noted. He had moderate ascites. Lab studies showed Hb of 9.2 g/dl, total bilirubin 2.2 mg/dl and CRP increased at 29.2 mg/l. CT chest with contrast showed small right pleural effusion and enlarged bilateral adrenal glands which were lobulated, heterogeneously enhancing and necrotic. Endoscopic Ultrasound(EUS) guided FNAC from adrenal gland aspirated purulent material which was sent for cytology. Tongue lesion biopsy was done. Adrenal FNAC showed small sized fungal spores with occasional budding yeast forms which were seen both intracellularly within macrophages and extracellularly in the necrosis. Giemsa stain highlighted the fungal spores. Tongue biopsy revealed similar findings. Findings were consistent with adrenal and tongue Histoplasmosis. Patient was treated with itraconazole and clinical improvement was seen within 4 weeks. Discussion: Non-healing tongue ulcer has a high suspicion for malignancy, especially in India where the oral cancer is widely prevalent. In our case, workup revealed Histoplasmosis in the setting of immunocompromised state due to underlying cirrhosis. Besides oropharyngeal involvement, H.capsulatum has also been reported to affect adrenal glands resulting in adrenal insufficiency. In India, where oral cancer is widely prevalent, oral histoplasmosis masquerading as carcinoma is not unknown. These lesions show complete resolution with itraconazole. DH has not been reported to the best of our knowledge in a patient with cirrhosis. Histoplasmosis is a rare differential diagnosis which should be considered in an immunocompromised host presenting with a non-healing oral cavity ulcer with adrenal mass in addition to other differentials of tuberculosis and malignancy.Figure. 4x5: cm tongue ulcer.Figure: EUS guided FNAC.Figure: Adrenal FNAC. Small sized fungal spores with occasional budding yeast forms seen both intracellularly within macrophages and extracellularly in the necrosis." @default.
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• W2914228045 date "2017-10-01" @default.
• W2914228045 modified "2023-10-18" @default.
• W2914228045 title "Unusual Cause of Non-healing Tongue Ulcer in a Cirrhotic Patient" @default.
• W2914228045 doi "https://doi.org/10.14309/00000434-201710001-02177" @default.
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