Disseminated histoplasmosis with orofacial involvement in HIV-I-infected patients with AIDS: manifestations and treatment.

Abstract

Histoplasmosis is a deep mycosis which is increasingly seen in HIV disease. It has emerged as a relatively common infection in Argentina, mainly in HIV-infected and other immunocompromised persons, and is often disseminated (DH). The aim of this study was to describe 32 HIV-I-seropositive patients with AIDS who had DH, 21 of whom presented orofacial manifestations, and their treatment. A retrospective study of 876 HIV-seropositive patients revealed 32 with a clinical diagnosis of DH confirmed by special stains on histopathologic specimens, or by culture. Thirty-two HIV-infected patients had DH. Two-thirds (21 patients) had oral lesions of histoplasmosis, of which six presented with oral cavity (OC) lesions as the sole orofacial manifestation of disease, nine patients presented oral and facial (OF) lesions and six presented facial lesions only. A unique case of submandibular histoplasmosis is also reported. Antifungal therapy cleared more than 90% of the orofacial and disseminated lesions of histoplasmosis. Over the 7-year period there was a mortality of 85%. DH should be considered as a possible diagnosis in HIV patients with chronic ulcerative or nodular orofacial or oral lesions. Itraconazole is an effective and acceptable therapy.