Oral exfoliative cytology in the diagnosis of histoplasmosis

A gingival manifestation of histoplasmosis leading diagnosis

Histoplasmosis is a world-wide distributed deep mycosis caused by Histoplasma capsulatum which has been endemic in many countries. We present a case involving an immunocompetent man evidencing the necessity of a multidisciplinary approach and rational requisition of exams. The disease has started as a pulmonary disease mimicking tuberculosis, although the exams have been negative. Immunodiffusion test indicate histoplasmosis, not confirmed by culture of sputum. After days the patient was forwarded by a private doctor for evaluation of oral lesions at our Department of Stomatology. An incisional biopsy revealed a nonspecific granulomatous inflammation and the Grocott-Gomori methenamine silver stain identified scarce oval structures that could represent fungal yeast. Sampling oral lesions with swab, it was observed the typical growth of H. capsulatum on culture. This case highlights the importance of doctor's integration diagnosing histoplasmosis, while a wide spectrum of clinical manifestations should be expected. Oral lesions may be the critical manifestation leading diagnosis.