Spontaneous Regression of Oral Histoplasmosis | Spontaneous Remission Database

Abstract

A case of histoplasmosis with an unusual clinical presentation and subsequent disease course was diagnosed when a tooth extraction site failed to heal. Culture, biopsy, and serologic study confirmed the presence of Histoplasma capsulatum. Radiographs and sputum culture established pulmonary involvement. Oral and pulmonary lesions regressed without treatment. This case is presented to raise the question of whether all cases of histoplasmosis with oral involvement should be assumed to be disseminated disease requiring treatment with amphotericin B.

Case Details

Personal Characteristics

51-year-old caucasian man, history of alcoholism since 1975, a productive cough of several years duration, and the smoking of two packs of cigarettes per day for many years

Clinical Characteristics

Tooth extraction site failed to heal, mandibular left central incisor was mobile and painful, the extraction site had not yet healed and the surrounding tissue was edematous and erythematous, a 1.0 centimeter irregular nodule overlying the anterior portion of the left third rib

Remission Characteristics

Approximately 2 months after the biopsy, the gingival lesion had healed but was still erythematous and periodically tender to palpation. The patient has been followed for 2 years, with no evidence of active histoplasmosis. The gingiva has remained normal in the affected area and chest radiographs since november 1977, have shown no evidence of active histoplasmosis. Histoplasma titers converted to negative in january 1979

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Tooth extraction, penicillin v therapy, 500 milligrams, four times a day

Additional Notes

The patients history revealed that he had cleaned chicken houses in the 1940s. It was decided that no treatment would be instituted unless there was a change in the patients physical or serologic findings. The patient continues to be followed at regular intervals for any evidence of active disease.