BMJ Case Reports 2017; doi:10.1136/bcr-2017-220364
  • Rare disease

Disseminated histoplasmosis presenting as multiple oral ulcers

  1. James B Cutrell
  1. Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Nicholas Hendren, nicholas.hendren{at}
  • Accepted 14 June 2017
  • Published 14 July 2017


A 61-year-old female with a history of advanced HIV disease and chronic hepatitis B was presented with an 8-week history of painful oral ulcers. She appeared systemically well but examination revealed multiple well-demarcated clean-based ulcers on the tongue and hard palate. Biopsy of one of the lesions showed numerous histiocytes containing intracellular yeast forms consistent with Histoplasma capsulatum var. capsulatum. Fungal blood cultures subsequently grew H. capsulatum var. capsulatum, confirming a diagnosis of disseminated histoplasmosis. She was treated with intravenous amphotericin B for 2 weeks followed by a prolonged course of oral itraconazole, with which her ulcers resolved completely and have not recurred. This case exemplifies how oral ulcers may be a manifestation of an underlying systemic disease and demonstrates the utility of biopsy in establishing a diagnosis.


  • Contributors NH and CY drafted the article. JM provided the images. JBC performed critical revision of the article. All authors were involved in the final approval of the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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