Etiology • A fungal infection caused by Histoplasma capsulatum • Fungus endemic to Ohio and Mississippi River valleys • Transmission: spore inhalation • Oral lesions usually secondary to pulmonary lesions with
hematogenous dissemination
Clinical Presentation • General symptoms usually mild • Oral lesions associated with disseminated form/prior
pulmonary lesions • Chronic ulcerations with necrosis, elevated nodular margins • May resemble squamous cell carcinoma • On the tongue, a cobblestone ulcer may be noted. • Oral ulcers persist until treatment of systemic disease.
hematogenous dissemination
Clinical Presentation • General symptoms usually mild • Oral lesions associated with disseminated form/prior
pulmonary lesions • Chronic ulcerations with necrosis, elevated nodular margins • May resemble squamous cell carcinoma • On the tongue, a cobblestone ulcer may be noted. • Oral ulcers persist until treatment of systemic disease.
Diagnosis • Demonstration of organisms in biopsy specimen • Culture • Serologic demonstration of antigen or antibodies
Differential Diagnosis • Tuberculosis • Squamous cell carcinoma • Other deep fungal infections (eg, coccidioidomycosis, crypto-
coccosis, and blastomycosis) • Chronic traumatic ulcer • Tertiary syphilis
Treatment • Sometimes none required • Amphotericin B • Ketoconazole, fluconazole, itraconazole
Prognosis • May recover spontaneously • Generally good unless immunosuppression present