Nodular variant of oral histoplasmosis without pulmonary involvement

Histoplasmosis is a mycotic disease caused by the dimorphic fungus Histoplasma capsulatum which exists as moulds in fertile and humid soil, rich in bird and bat droppings and as yeast in infected tissues. It is classified clinically as acute pulmonary, chronic pulmonary or disseminated form. Oral manifestations account for 25-40% of the disseminated form of the disease and can present as solitary, variably painful, shallow or deep ulcer or less commonly in the form of nodules. It is commonly found in immune compromised patients. Diagnosis of histoplasmosis can be established by identification of fungus from infected tissues and/or culture studies. Presence of fungal yeasts are best demonstrated by staining the sections with Periodic Acid Schiff (PAS) and Grocott Gomori methenamine silver (GMS) stain which demonstrate the characteristic 1-2 micron yeasts of Histoplasma capsulatum. Treatment modalities include, administration of antifungal drugs like intravenous Amphotericin B, oral Itraconazole or Ketoconazole but proper monitoring of hepatic function is essential. A unique case of localised, nodular variant of Histoplasmosis involving the hard palate in an immune competent patient without pulmonary involvement has been discussed with emphasis on clinicopathological and histological features along with treatment modalities.