DISSEMINATED HISTOPLASMOSIS WITH ORAL MANIFESTATION IN A PATIENT WITH CROHN´S DISEASE
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Published:
Oct 29, 2024
Keywords:
Histoplasmosis, Disseminated fungal infection, Oral diseases, Autoimmune disease, Crohn's disease
Main Article Content
Abstract
Histoplasmosis and Crohn's Disease (CD) can resemble each other in clinical characteristics, thus complicating the diagnosis by the doctor or dentist. Through a clinical case, this work aims to demonstrate the diagnostic challenge of a single histoplasmosis lesion in the oral cavity in a patient with chronic granulomatous disease. The histopathological examination found it to be an oral lesion resulting from a specific granulomatous process, subsequently diagnosed as histoplasmosis after microbiological culture of the lesion. The systemic medical evaluation did not identify lesions compatible with histoplasmosis in other organs. After appropriate therapy, the fungal infection was remission, and therapeutic follow-up of the autoimmune disease was performed. The co-occurrence of histoplasmosis in patients with CD is a possibility to be considered, especially due to the potential state of immunosuppression associated with this condition. Although the anatomopathological examination may not detect the microorganism in the tissue sample, this case demonstrated that microbiological culture should be considered an essential complementary examination for diagnosing deep mycoses.
Article Details
How to Cite
Fossalussa da Silva, C., Angélica de Paiva Paula, C., Borba Carneiro, T., Mota Loyola, A., & César Guimarães Henriques, J. (2024). DISSEMINATED HISTOPLASMOSIS WITH ORAL MANIFESTATION IN A PATIENT WITH CROHN´S DISEASE. Naval Dental Jounal, 51(2), 43-49. https://doi.org/10.69909/1983-7550-histoplasmose-5
Section
Case Reports
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
1. Bokemeyer A, Tentrop N, Barth PT, Lenze F, Hengst K, Kleinheinz J, et al. Successful treatment of oral Crohn’s disease by anti-TNF-alpha dose escalation - a case report. BMC Gastroenterol. 2018 Jun 18;18(1):88.
2. Jianzhong H. The genetic predisposition and the interplay of host genetics and gut microbiome in Crohn disease. Clin Lab Med. 2014;34:763-70.
3. Oghan F, Pekkan G, Ozveren O. Saddle nose deformity, palatalperforation and truncus arteriosus in a patient with Crohn’s disease. Craniomaxillofac Surg. 2012 Jan;40(1):17-9.
4. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590-605.
5. Thrash B, Patel M, Shah KR, Boland CR, Menter A. Cutaneous Manifestations of Gastrointestinal Disease:Part II. J Am Acad Dermatol. 2013;68:244-6.
6. Tan CX, Brand HS, de Boer NK, Forouzanfar T. Gastrointestinal diseases and their oro-dental manifestations: Part 1: Crohn’s disease. Br Dent J. 2016 Dec 16;221(12):794-9.
7. Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol. 2006;14(12):4819-31.
8. Strober W, Fuss I, Kitani A. Regulation of experimental mucosal inflammation. Acta Odontol Scand. 2001;59:244-7.
9. Dupuy A, Cosnes J, Revuz J, Delchier JC, Gendre JP, Cosnes A. Longterm evolution of oral localisation of Crohn’s disease. Gastroenterology. 1998;114:A956.
10. Cosnes J, Nion-Larmurier I, Afchain P, Beaugerie L, Gendre J-P.Gender differences in the response of colitis to smoking. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2004;2:41-8.
11. Loddo I, Romano C. Inflammatory bowel disease: Genetics, epigenetics, and pathogenesis. Front Immunol. 2015;6:6-11.
12. Zhao XS, Wang ZT, Wu ZY, Yin QH, Zhong J, Miao F, et al. Differentiation of Crohn’s disease from intestinal tuberculosis by clinical and CT enterographic models. Inflamm Bowel Dis. 2014;20:916-25.
13. Hussey S, Fleming P, Rowland M, Harty S, Chan L, Broderick A, et al. Disease outcome for children who present with oral manifestations of Crohn’s disease. Eur Arch Paediatr Dent. 2011;12(3):167-9.
14. Sanderson J, Nunes C, Escudier M, Barnard K, Shirlaw P, Odell E, et al. Oro-facial granulomatosis: Crohn’s disease or a new inflammatory bowel disease?. Inflamm Bowel Dis. 2005;11:840-6.
15. Kolho KL, Ainamo A. Progress in the treatment and outcome of pediatric inflammatory bowel disease patients. Expert Rev Clin Immunol. 2016 Dec;12(12):1337-45.
16. Litsas G. Crohn’s disease of the mouth: report of a case. Eur J Paediatr Dent 2011;12:1-3.
17. Jajam M, Bozzolo P, Niklander S. Oral manifestations of gastrointestinal disorders. J Clin Exp Dent. 2017;10:1242-8.
18. Rezaie A, Kuenzig ME, Benchimol EI, Griffiths AM, Otley AR, Steinhart H, et al. Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2015;6:CD000296.
19. Pittock S, Drumm B, Fleming P, McDermott M, Imrie C, Flint S, et al. The oral cavity in Crohn’s disease. J Pediatr. 2001;138:767-71.
20. Triantafillidis JK, Valvi FZ, Merikas E, Peros G, Galitis ON, Gikas A. Granulomatous cheilitis associated with exacerbations of Crohn’s disease: a case report. J Med Case Rep. 2008 Feb 25;2:60.
21. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV. Risk factors associated with progression to intestinal complications of Crohn’s disease in a populationbased cohort. Gastroenterology. 2010;139:1147-55.
22. William T, Marsch WC, Schmidt F, Kreft B. Early oral presentation of Crohn’s disease. JDDG. 2007;5:678-9.
23. Eckel A, Lee D, Deutsch G, Maxin A, Oda D. Oral manifestations as the first presenting sign of Crohn’s disease in a pediatric patient. J Clin Exp Dent. 2017 Jul 1;9(7):e934-e938.
24. Gundacker ND, Rolfe RJ, Rodriguez JM. Infections associated with adventure travel: a systematic review. Trav Med Infect Dis. 2017;16:3-10.
25. Akran SM, Koirala J. Histoplasmosis. Treasure Island; 2023.
26. Heninger E, Hogan LH, Karman J, Macvilay S, Hill B, Woods JP, et al. Characterization of the Histoplasma capsulatuminduced granuloma. J Immunol. 2006;177(5):3303-13.
27. Azar MM, Hage CA. Laboratory diagnostics for histoplasmosis. J Clin Microbiol. 2017;55(6):1612-20.
28. Skrzat A, Kowalczyk DO, Szybka AT. Crohn’s disease should be considered in children with inflammatory oral lesions. Acta Paediatr. 2016;106:199-203.
29. Falci DR, Monteiro AA, Braz CFC, Magalhães TCO, Xavier MO, Basso RP, et al. Histoplasmosis, na underdiagnosed disease affecting people living with HIV/AIDS in Brazil: results of a multicenter prospective cohort study using both classical mycology testes and Histoplasma Urine Antigen Detection. Open Forum Infect Dis. 2019;6(4):ofz073.
30. Mignogna MD, Fedele S, Lo Russo L, Ruoppo E, Lo Muzio L. A case of oral localized histoplasmosis in an immunocompetent patient. Eur J Clin Microbiol Infect Dis. 2001;20(10):753-5.
2. Jianzhong H. The genetic predisposition and the interplay of host genetics and gut microbiome in Crohn disease. Clin Lab Med. 2014;34:763-70.
3. Oghan F, Pekkan G, Ozveren O. Saddle nose deformity, palatalperforation and truncus arteriosus in a patient with Crohn’s disease. Craniomaxillofac Surg. 2012 Jan;40(1):17-9.
4. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590-605.
5. Thrash B, Patel M, Shah KR, Boland CR, Menter A. Cutaneous Manifestations of Gastrointestinal Disease:Part II. J Am Acad Dermatol. 2013;68:244-6.
6. Tan CX, Brand HS, de Boer NK, Forouzanfar T. Gastrointestinal diseases and their oro-dental manifestations: Part 1: Crohn’s disease. Br Dent J. 2016 Dec 16;221(12):794-9.
7. Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol. 2006;14(12):4819-31.
8. Strober W, Fuss I, Kitani A. Regulation of experimental mucosal inflammation. Acta Odontol Scand. 2001;59:244-7.
9. Dupuy A, Cosnes J, Revuz J, Delchier JC, Gendre JP, Cosnes A. Longterm evolution of oral localisation of Crohn’s disease. Gastroenterology. 1998;114:A956.
10. Cosnes J, Nion-Larmurier I, Afchain P, Beaugerie L, Gendre J-P.Gender differences in the response of colitis to smoking. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2004;2:41-8.
11. Loddo I, Romano C. Inflammatory bowel disease: Genetics, epigenetics, and pathogenesis. Front Immunol. 2015;6:6-11.
12. Zhao XS, Wang ZT, Wu ZY, Yin QH, Zhong J, Miao F, et al. Differentiation of Crohn’s disease from intestinal tuberculosis by clinical and CT enterographic models. Inflamm Bowel Dis. 2014;20:916-25.
13. Hussey S, Fleming P, Rowland M, Harty S, Chan L, Broderick A, et al. Disease outcome for children who present with oral manifestations of Crohn’s disease. Eur Arch Paediatr Dent. 2011;12(3):167-9.
14. Sanderson J, Nunes C, Escudier M, Barnard K, Shirlaw P, Odell E, et al. Oro-facial granulomatosis: Crohn’s disease or a new inflammatory bowel disease?. Inflamm Bowel Dis. 2005;11:840-6.
15. Kolho KL, Ainamo A. Progress in the treatment and outcome of pediatric inflammatory bowel disease patients. Expert Rev Clin Immunol. 2016 Dec;12(12):1337-45.
16. Litsas G. Crohn’s disease of the mouth: report of a case. Eur J Paediatr Dent 2011;12:1-3.
17. Jajam M, Bozzolo P, Niklander S. Oral manifestations of gastrointestinal disorders. J Clin Exp Dent. 2017;10:1242-8.
18. Rezaie A, Kuenzig ME, Benchimol EI, Griffiths AM, Otley AR, Steinhart H, et al. Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2015;6:CD000296.
19. Pittock S, Drumm B, Fleming P, McDermott M, Imrie C, Flint S, et al. The oral cavity in Crohn’s disease. J Pediatr. 2001;138:767-71.
20. Triantafillidis JK, Valvi FZ, Merikas E, Peros G, Galitis ON, Gikas A. Granulomatous cheilitis associated with exacerbations of Crohn’s disease: a case report. J Med Case Rep. 2008 Feb 25;2:60.
21. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV. Risk factors associated with progression to intestinal complications of Crohn’s disease in a populationbased cohort. Gastroenterology. 2010;139:1147-55.
22. William T, Marsch WC, Schmidt F, Kreft B. Early oral presentation of Crohn’s disease. JDDG. 2007;5:678-9.
23. Eckel A, Lee D, Deutsch G, Maxin A, Oda D. Oral manifestations as the first presenting sign of Crohn’s disease in a pediatric patient. J Clin Exp Dent. 2017 Jul 1;9(7):e934-e938.
24. Gundacker ND, Rolfe RJ, Rodriguez JM. Infections associated with adventure travel: a systematic review. Trav Med Infect Dis. 2017;16:3-10.
25. Akran SM, Koirala J. Histoplasmosis. Treasure Island; 2023.
26. Heninger E, Hogan LH, Karman J, Macvilay S, Hill B, Woods JP, et al. Characterization of the Histoplasma capsulatuminduced granuloma. J Immunol. 2006;177(5):3303-13.
27. Azar MM, Hage CA. Laboratory diagnostics for histoplasmosis. J Clin Microbiol. 2017;55(6):1612-20.
28. Skrzat A, Kowalczyk DO, Szybka AT. Crohn’s disease should be considered in children with inflammatory oral lesions. Acta Paediatr. 2016;106:199-203.
29. Falci DR, Monteiro AA, Braz CFC, Magalhães TCO, Xavier MO, Basso RP, et al. Histoplasmosis, na underdiagnosed disease affecting people living with HIV/AIDS in Brazil: results of a multicenter prospective cohort study using both classical mycology testes and Histoplasma Urine Antigen Detection. Open Forum Infect Dis. 2019;6(4):ofz073.
30. Mignogna MD, Fedele S, Lo Russo L, Ruoppo E, Lo Muzio L. A case of oral localized histoplasmosis in an immunocompetent patient. Eur J Clin Microbiol Infect Dis. 2001;20(10):753-5.