LOCALIZED HISTOPLASMOSIS IN THE MOUTH AS A PRIMARY MANIFESTATION OF HIV INFECTION

A 61-year-old male, without comorbidities, presented with an ulcer on the dorsal surface of the tongue, 4 cm size, with irregular and raised edges. The patient was forwarded to the infectiology group with a previous biopsy without conclusive result, which excluded malignancy and investigation of HIV due to oral lesion. A biopsy was performed and was sent for anatomopathologic analysis, culture of bacteria and fungi, mycobacteria, and PCR for leishmania. Chest radiograph showed no abnormalities, and HIV was confirmed with quantification of viral load (50.818/mL) and CD4 (59/mm3). The culture for fungi and anatomopathologic examination with GMS staining concluded the presence of Histoplasma capsulatum. The rare occurrence of localized histoplasmosis as the first manifestation of HIV was confirmed. The use of TARV was instituted, and the treatment was performed with itraconazole 600 mg/d for 180 days, followed by 200 mg/d for 12 months. On reevaluation after 7 months’ of treatment, partial lesion regression was observed, and total after 12 months.