UNIQUE CLINICAL PRESENTATIONS OF DEEP FUNGAL INFECTIONS INVOLVING THE ORAL CAVITY: A REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Abstract

Oral alterations associated with systemic fungal infections typically present as chronic mucosal ulceration or granular soft tissue overgrowth, mimicking malignancy. We report two cases of deep fungal infections exhibiting unusual oral findings. Case 1: A 73-year-old male presented with one-month history of bilateral ulcerations of the oral commissures, with significant involvement of the perioral facial skin. With a clinical diagnosis of angular cheilitis and to exclude malignancy, incisional biopsy was performed. Histopathologic evaluation showed chronically inflamed granulation tissue and staining by the GMS method revealed numerous yeast forms, consistent with Histoplasma capsulatum. Systemic itraconazole (400 mg daily) resulted in uneventful resolution. Case 2: A 49- year-old male presented for evaluation of a non- healing extraction socket of the posterior mandible. The patient's medical history was significant for renal cell carcinoma recently treated with complete nephrectomy of the affected kidney. A large, ulceroproliferative soft tissue mass was noted in association with the extraction socket, with mobility of the adjacent dentition. Together with an ill-defined radiolucency on panoramic radiograph, concern was raised for metastatic disease. Incisional biopsy showed subacutely inflamed granulation tissue supporting numerous multinucleated giant cells in association with occasional large yeasts, consistent with Blastomyces dermatitidis. While uncommon, deep fungal infections may involve oral and maxillofacial structures, including both soft tissues and gnathic bones. Vigilance regarding this diagnostic consideration can support timely diagnosis and proper treatment.