J Dermatol Case Rep 2013 1, pp 25-26 Disseminated histoplasmosis with initial oral manifestations Surabhi Sinha 1 , Kabir Sardana 2 , Vijay K. Garg 2 1. Department of Dermatology, S.T.D. and Leprosy, Dr. RML Hospital, New Delhi — 110001, India; 2. Department of Dermatology, Venereology and Leprology, Maulana Azad Medical College, New Delhi — 110002, India. Corresponding author: Dr. Surabhi Sinha, Specialist, Department of Dermatology, S.T.D. and Leprosy, Dr. RML Hospital, New Delhi — 110001, India. E-mail: surabhi2310@gmail.com Histoplasmosis is a systemic fungal disease that may present in a variety of clinical manife- stations. Involvment of the oral mucosa is very rare and may occur as part of disseminated hi- stoplasmosis or as isolated involvement. A 48-year-old farmer from Madhya Pradesh, India, presented with painful eroded raised le- sions in his oral cavity for three months and asymp- tomatic disseminated, skin-colored, raised cuta- neous lesions for one month prior to admission. Ten days later, he developed fever and cough. On examination, the patient had submandibu- lar and cervical lymphadenopathy. Bronchial breath sounds were heard in right mammary area with increased vocal resonance. Hepato- splenomegaly was also present. Mucocutaneous examination revealed numerous skin-colored to erythematous papules and small nodules 0.3 to 1.2 cm, present over the eyelids, forehead, pin- nae, neck, forearms and abdomen (Fig. 1A). Few lesions showed central umbilication mimicking DOI: http://dx.doi.org/10.3315/jdcr.2013.1132 25 PHOTOLETTER TO THE EDITOR Abstract Histoplasmosis is a systemic fungal disease that may present in a variety of clinical manifestations. Involvment of the oral mucosa is very rare and may occur as part of disseminated histoplasmosis or as isolated involvement. We present a pa- tient with disseminated histoplasmosis, in whom oral lesions were the initial manifestation of the disease. (J Dermatol Case Rep. 2013; 7(1): 25-26) Key words: AIDS, Fungal infection, HIV, mucous membrane, histoplasma, oral mucosa, tongue Figure 1 (A): Photograph of the face showing dome – shaped and typical umbilica- ted papules over the eyelids, glabella and eyebrows (published with pa- tient’s consent). (B): Photograph of the tongue showing atrophic glossitis with papules, few eroded, over the dorsum of the tongue.