Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2018.046
Autopsy and Case Reports
Article / Clinical Case Report

Oral ulcerative lesions in a post-liver-transplantation patient

Gabriele Prospero Nakamura; Renata Mendonça Moraes; Juliana Mota Siqueira; Andrea Cruz Ferraz de Oliveira; Maria Dirlei Ferreira de Souza Begnami; Graziella Chagas Jaguar

Downloads: 0
Views: 316

Abstract

Oral involvement is rarely found in histoplasmosis, except in its disseminated form, which is mostly observed in the severely immunocompromised host. Herein, we presented the case of a 36-year-old female with a previous history of liver transplant, who was hospitalized due to fever, chills, night sweats, diarrhea, and painful oral lesions over the last 3 days. The oral examination revealed the presence of painful shallow ulcers lined by a pseudomembrane in the gingiva and the soft and hard palate. The initial working diagnosis comprised cytomegalovirus reactivation or herpes simplex virus infection. The diagnostic work-up included incisional biopsies of the gingiva and the sigmoid colon. Both biopsies confirmed the diagnosis of histoplasmosis. Intravenous itraconazole was administered with significant improvement after 7 days. Although oral involvement is rare, histoplasmosis should be included in the differential diagnosis of oral lesions, particularly when the patient is immunosuppressed. This study reports a rare presentation of histoplasmosis involving the mucosa of the oral cavity and the colon.

Keywords

Histoplasmosis, Liver Transplantation, Oral ulcer, Immunosuppression

References

Souza BC, Munerato MC. Oral manifestation of histoplasmosis on the palate. An Bras Dermatol. 2017;92(5, Suppl 1):107-9. 10.1590/abd1806-4841.20175751.29267463

Wheat LJ, Slama TG, Zeckel ML. Histoplasmosis in the acquired immune deficiency syndrome. Am J Med. 1985;78(2):203-10. 10.1016/0002-9343(85)90427-9.3871588

Yadav SK, Saigal S, Choudhary NS, Saha S, Kumar N, Soin AS. Cytomegalovirus infection in liver transplant recipients: current approach to diagnosis and management. J Clin Exp Hepatol. 2017;7(2):144-51. 10.1016/j.jceh.2017.05.011.28663679

López-Oliva MO, Flores J, Madero R, et al. Cytomegalovirus infection after kidney transplantation and long-term graft loss. Nefrologia. 2017;37(5):515-25. 10.1016/j.nefro.2016.11.018.28946964

Simon DM, Levin S. Infectious complication soft solid organ transplantations. Infect Dis Clin North Am. 2001;15(2):521-49. 10.1016/S0891-5520(05)70158-6.11447708

Arduino PG, Porter SR. Herpes simplex virustype 1 infection: overview onrelevantclinico-pathological features. J Oral Pathol Med. 2008;37(2):107-21. 10.1111/j.1600-0714.2007.00586.x.18197856

Al-Dhafiri SA, Molinari R. Herpetic folliculitis. J Cutan Med Surg. 2002;6(1):19-22. 10.1177/120347540200600104.11896419

Levitsky J, Duddempudi AT, Lakeman FD, et al. Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transpl. 2008;14(10):1498-504. 10.1002/lt.21567.18825709

Iqbal F, Schifter M, Coleman HG. Oral presentation of histoplasmosis in an immunocompetent patient: a diagnostic challenge. Aust Dent J. 2014;59(3):386-8. 10.1111/adj.12187.24819556

 

 

 


Publication date:
01/14/2019

5c3cdbe90e8825a90acd6224 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections