Description

We describe a case of chronic tongue ulceration with systemic symptoms in a patient with poorly controlled diabetes. A biopsy of a lesion from the posterior third of the tongue showed features typical of histoplasmosis (figure 1). A CT of the thorax and abdomen revealed a diffuse reticulonodular pattern bilaterally (figure 2A). The intra-abdominal organs were normal. A diagnosis of disseminated histoplasmosis was made. The patient was started on intravenous amphotericin B for 3 weeks followed by oral itraconazole 100 mg twice a day for 1 month. A repeat CT thorax 6 weeks after antifungal treatment revealed resolution of the lesions (figure 2B).

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Figure 1

Tissue biopsy taken from the tongue lesion shows multinucleated giant cells containing encapsulated fungal organism.

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Figure 2

(A) CT of the thorax showing a diffuse reticulonodular pattern bilaterally which was more evident in the upper and middle zones. (B) CT of the thorax showing resolution of the reticulonodular shadowing 6 weeks after treatment.

Disseminated histoplasmosis refers to a process of severe fungus colonisation in the lungs and other organs and body sites 1 The first ever case of disseminated histoplasmosis in a patient with diabetes living in a non-endemic area was reported in 1977.2 Since the AIDS epidemic, disseminated histoplasmosis is more commonly seen. Chronic infection often presents with pancytopenia, hepatosplenomegaly, hepatitis and oropharyngeal or gastrointestinal lesions.3 A definitive diagnosis requires a positive blood culture or histological demonstration in involved tissue.3