Perforation of the Nasal Septum as the First Sign of Histoplasmosis Associated with AIDS and Review of Published Literature

• Published in: Mycopathologia (1975) Vol. 176; no. 1-2; pp. 145 - 150
• Main Authors: Jaimes, Angel, Muvdi, Sandra, Alvarado, Zulma, Rodríguez, Gerzaín
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-08-2013; Springer; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - complications; Adult; AIDS; AIDS (Disease); Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Biomedical and Life Sciences; Biopsy; Diagnosis; Eukaryotic Microbiology; Female; Fungi; Histoplasma - isolation & purification; Histoplasma capsulatum; Histoplasmosis; Histoplasmosis - diagnosis; Histoplasmosis - drug therapy; Histoplasmosis - pathology; HIV; Human immunodeficiency virus; Humans; Itraconazole - therapeutic use; Leishmania; Life Sciences; Male; Medical Microbiology; Microbial Ecology; Microbiology; Microorganisms; Nasal Septal Perforation - etiology; Nasal Septal Perforation - pathology; Parasitic diseases; Pathogens; Patients; Plant Sciences; Protozoa; Skin; South America; Ulcers; South America; Colombia; Histoplasmosis; AIDS-related opportunistic infections; Mucocutaneous; Leishmaniasis; Nasal septal perforation
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-013-9662-z

Disseminated histoplasmosis in South America is associated with AIDS in 70–90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but
Histoplasma capsulatum
. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for
Leishmania
were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm
3
and in the female 133/mm
3
. The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of
H. capsulatum
, findings which demonstrated that both patients had AIDS.