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| Fig. 32.7 Histoplasmosis. Oral ulcerations in an HIV-infected patient. Histoplasmosis more commonly affects the oral mucosa than the skin. (Courtesy of James E. Fitzpatrick, MD.) |
Three different patterns of disseminated histoplasmosis are described: acute, subacute, and chronic. The acute syndrome generally occurs in immunosuppressed patients and is characterized by fever, hepatosplenomegaly, and pancytopenia, with 18% developing mucocutaneous ulcers. Chronic disseminated histoplasmosis is characterized by involvement of the bone marrow, gastrointestinal tract, spleen, adrenals, and central nervous system (CNS); 67% have painful ulcerations on the tongue, buccal mucosa, gingiva, or larynx (Fig. 32-7). The treatment of choice is itraconazole and, for severe diseases and immunosuppressed patients, amphotericin.
