Unique Oral Presentations of Deep Fungal Infections: A Report of Four Cases
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CASE REPORTS
Unique Oral Presentations of Deep Fungal Infections: A Report of Four Cases Vimi S. Mutalik1 · Caroline Bissonnette2 · John R. Kalmar2 · Kristin K. McNamara2 Received: 20 July 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Deep fungal infections rarely involve the oral cavity and most commonly affect immunocompromised patients. Oral deep fungal infections typically manifest as chronic mucosal ulcerations or granular soft tissue overgrowths. Since these lesions are non-specific and can mimic malignancy, it is crucial to obtain a thorough clinical history and an adequate biopsy to render the appropriate diagnosis. We report four new cases of deep fungal infections, diagnosed as histoplasmosis, blastomycosis and chromoblastomycosis, exhibiting unique oral and perioral presentations. Awareness of these unusual entities can help dental and medical practitioners expedite proper multidisciplinary care and minimize morbidity and mortality. Keywords Invasive fungal infections · Mycoses · Oral · Mouth · Blastomycosis · Histoplasmosis · Chromoblastomycosis
Introduction Fungal infections may present as superficial cutaneous or mucosal disease, with evidence of local invasion or as more serious disseminated systemic infections [1]. While candidiasis is the most common superficial fungal infection routinely encountered in the oral cavity, deep fungal infections can also occur intraorally. Associated risk factors include immunodeficiency, use of immunosuppressive/immunemodulatory medications or chemotherapeutic agents [2]. Fortunately, when the host has an intact immune system, exposure to fungal organisms typically does not progress to infection [1]. Herein, we present four challenging cases of deep fungal infection involving the oral and perioral mucosa. Awareness of these varied clinical presentations, their unique occurrence in immunocompetent individuals, and the importance of supportive medical management are Vimi S. Mutalik and Caroline Bissonnette have contributed equally. * Kristin K. McNamara [email protected] 1
Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, MB, Canada
Division of Oral and Maxillofacial Pathology and Radiology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210, USA
2
highlighted in this case series. This study was approved by The Ohio State University Biomedical Sciences Institutional Review Board (Study ID 2019H0451).
Case 1 A 72-year-old male presented to the head and neck surgical oncology clinic for evaluation of painful ulcers involving the oral commissures bilaterally. The patient reported that these lesions had been present for one month with gradual increase in size. Oral intake was limited due to increasing pain, which resulted in a 40 lb. weight loss. A course of Augmentin and topical application of Vaseline failed to improve his condition. His past medical history was significant for shortness of breath and a cutaneous
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