PMC6394359_01
Gross examination of the oral lesions. A - Flat lesion covered with a fibrin pseudo membrane with regular erythematous borders on the hard palate; B - Ulcer on the vestibular and palatal gingiva between the 16 and 17 teeth; C - Ulcer on the left soft palate near the uvula.
autopsy-09-01e2018046-g01.jpg
PMC6394359_01_autopsy-09-01e2018046-g01.jpg
g01
The oral examination showed three well-defined shallow ulcerative lesions covered by fibrin with regular erythematous borders on the hard palate, measuring 1 cm (Figure 1A); on the vestibular and palatal gingiva between the 16 and 17 teeth measuring 0.5 cm (Figure 1B); and on the left soft palate near the uvula measuring 1.0 cm (Figure 1C).
Colonoscopy image depicting area of inflammatory process with mucosal erosion and ulceration in the descending colon.
autopsy-09-01e2018046-g02.jpg
PMC6394359_01_autopsy-09-01e2018046-g02.jpg
g02
The colonoscopy image showed areas with inflammatory process and eroded mucosa with an extensive ulcer measuring 2 cm on the descending colon extending to the rectum (Figure 2).
Photomicrograph of the oral biopsy. A - Areas of squamous mucosa with intense histiocytic inflammatory infiltrate associated with rounded fungal structures consistent with Histoplasma spp. (H&E 200X); B - Gomori-Grocott's staining showing positivity for fungi (H&E 200X).
autopsy-09-01e2018046-g03.jpg
PMC6394359_01_autopsy-09-01e2018046-g03.jpg
g03
Histological sections of oral cavity biopsies revealed fragments of squamous mucosa with intense histiocytic inflammatory infiltrate associated with rounded fungal structures, which were consistent with H. capsulatum, and were confirmed by Gomori-Grocott's staining in the gum and the palate (Figure 3).
Photomicrograph of the rectal biopsy. A - Areas with intense histiocytic inflammatory infiltrate associated with rounded fungal structures consistent with Histoplasma spp. (H&E 400X); B - Gomori-Grocott staining showing positivity for fungi(400X).
autopsy-09-01e2018046-g04.jpg
PMC6394359_01_autopsy-09-01e2018046-g04.jpg
g04
Based on the clinical and histopathologic findings, the final diagnosis was histoplasmosis (Figure 4).
Oral examination after the treatment. Note the complete healing of the lesions on the hard palate (A), gingiva (B), and soft palate (C).
autopsy-09-01e2018046-g05.jpg
PMC6394359_01_autopsy-09-01e2018046-g05.jpg
g05
The treatment consisted of itraconazole 300 mg/day with significant improvement of local and systemic symptoms after 7 days (Figure 5).