1/5. Epiglottic histoplasmosis presenting in a nonendemic region: a clinical mimic of laryngeal carcinoma.histoplasma capsulatum is a dimorphic fungus endemic to north america. histoplasmosis is primarily an inhalation-acquired mycosis that is encountered rarely outside of endemic regions. In nonendemic regions, histoplasmosis may present a diagnostic challenge and both clinical and laboratory vigilance are required to accurately identify infection. Unusual clinical presentations with limited physical findings may compound the difficulty in diagnosis. We describe a 78-year-old retired soil science professor who presented with an eroded epiglottic mass secondary to disseminated histoplasmosis in a nonendemic region (alberta). Clinically, this mass was thought to represent a primary laryngeal carcinoma, as no other buccal or oropharyngeal ulcers were identified. histoplasmosis was confirmed by tissue biopsy and a positive immunodiffusion test for immunoglobulin g. Disseminated histoplasmosis is often associated with laryngeal and oropharyngeal disease; however, isolated epiglottic histoplasmosis is rare. histoplasmosis should be included in the differential diagnosis of neoplasms and chronic ulcers of the upper aerodigestive tract.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Chronic pulmonary histoplasmosis with an oral lesion.histoplasmosis is a fungal disease resulting from inhalation of airborne spores of the organism histoplasma capsulatum. The disease is endemic to the ohio and mississippi river valleys. Oral lesions are not common, but when present, they are usually associated with the severe disseminated form of histoplasmosis. This particular case is presented as an example of chronic pulmonary histoplasmosis in which a localized gingival lesion represented the initial clinical manifestation of the disease. diagnosis was based on a positive biopsy and the results of chest radiographic examination. If, as in this case, serologic, hematologic, and physical examination results are negative, the biopsy of suspicious lesions is of paramount importance to the clinical differential diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Mediastinal fibrosis complicating histoplasmosis.Mediastinal fibrosis, the most serious late complication of remote infection by histoplasma capsulatum, is a thick, dense fibrotic capsule which surrounds a small mediastinal focus of old caseous adenitis. The fibrotic process may accrue over prolonged periods and extend within the lumina of critical mediastinal structures to produce complete occlusion. We summarized clinical and radiographic data for 71 patients with mediastinal fibrosis; the criteria for inclusion were the clinical demonstration of occlusion of major central airways (trachea or mainstem bronchus) or major vessels (pulmonary arteries or veins) and the absence of other disease processes which might cause such obstruction. We selected 65 patients who met these criteria from the medical literature of the last 40 years and report 6 new cases from our experience. The majority of patients were diagnosed between ages 20 and 40. The most common symptoms included hemoptysis, dyspnea, and cough. An accentuated pulmonic component of the second heart sound, wheezing, and localized murmur were among the physical findings reported. Radiographic abnormalities consisted of mass lesions and atelectasis or infiltrates, but were often nonspecific. Chest radiography was deceptively normal in some patients, even in the presence of major central airway or vascular occlusion, especially when the focus was subcarinal. Computed tomography has particular promise to depict the mediastinal abnormalities in this process. Surgery had minimal therapeutic benefit. Because of incomplete followup, the mortality of 30% in this series surely does not represent the true overall mortality of mediastinal fibrosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. The long-term course of multifocal choroiditis (presumed ocular histoplasmosis).We studied 40 patients with the presumed ocular histoplasmosis triad for ten to 15 years. Another patient developed the choroidal features of the syndrome in previously normal eyes. The basic lesion is a nodular choroidal infiltrate that evolves from clinically and angiographically normal retina. It is initially hypofluorescent and has an overlying serous detachment. It evolves through episodes of serous detachment and hyperfluorescence into a choroidal scar with breaks in Bruch's membrane and occasional subretinal neovascularization. Seven of 42 eyes (16.6%) developed new choroidal infiltrates in choroid and retina that were clinically and angiographically normal more than ten years ago. After ten years about 50% of eyes with central scars will have visual acuity changes of 3 or more lines because of progressive remodeling and extension of the disciform scar. Nine of 40 fellow eyes (22.5%) sustained a disciform process during the entire follow-up period. One patient developed typical choroidal lesions in previously normal fundi. Results of extensive physical and laboratory tests for histoplasmosis and other diseases were normal.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Oral histoplasmosis in india: a case report and an overview of cases reported during 1968-92.Oral histoplasmosis in a 30-year-old male with no history of travel outside india is described. An ulcerating lesion was located on the hard palate. A chest X-ray was normal. Based on physical examination, regional lymph nodes, liver and spleen were not involved. The diagnosis was established by demonstrating yeast-like budding cells in a biopsy of the lesion and by isolating histoplasma capsulatum in pure culture. The identity of the isolate was confirmed by a chemiluminescent dna-probe assay and the exoantigen test. A review of the Indian literature from 1968 to 1992 revealed the occurrence of 25 authentic cases of histoplasmosis in india. In 19 cases, lesions were confined to the oral cavity confirming prior observation that histoplasmosis in Indian patients tends to occur primarily in extrapulmonary sites, particularly the oral cavity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |