- Coccidioidomycosis was first discovered in 1892 and can be acquired by inhalation or inoculation of the organism through the skin.
- Skin manifestations of the disease include papule, nodules, and verrucous lesions that may evolve to an ulcer or abscess.
- Coccidioidomycosis typically involves the lungs and rarely presents in the mouth.
A 60-year-old man from northern Mexico presented with a 1.5 cm ulcerated lesion on the left lateral border of the tongue. According to the patient, the lesion had appeared 5 months ago. His medical history revealed that he did not have any systemic disease, nor did he ever smoke. Epidermoid carcinoma was considered as the primary diagnosis considering the patient’s poor oral health, age and clinical aspects. The lesion was biopsied. Histopathological analysis of the lesion was consistent with the diagnosis of coccidiodomycosis.
Ulcerated lesions in the mouth are quite common and can have different causes. The most common causes are trauma, infections and epidermoid carcinoma. In case of epidermoid carcinoma, the lesion generally presents as a single ulcerated lesion in adults and elderly patients. Infections that may cause ulcers in the mouth include herpes simplex virus and syphilis. Less common diseases, particularly fungal infections (histoplasmosis, aspergillosis, cryptococcosis, paracoccidioidomycosis, and coccidioidomycosis) should be ruled out depending on the immunologic status of the patient.
In many cases, tuberculosis, less commonly leishmaniasis and rarely hanseniasis have also been found in the mouth. Early and correct diagnosis is important for treatment.
Treatment and follow-up
The patient was referred to the infectious disease department and the diagnosis of coccidioidomycosis was confirmed. Chest X-ray showed pulmonary lesions. He was prescribed systemic antifungal therapy, itraconazole 200 mg, 1 tablet by mouth per day during breakfast for 3 months. Treatment was continued for another three months after assessing liver function. After 3 months liver function was assessed again which showed an alteration in results, therefore, treatment was discontinued for a month.
The treatment was then continued again for three months. The treatment was extended for a year after there was no evidence of the infection being eradicated.
References
Ulcerated Lesion of the Tongue as Manifestation of Systemic Coccidioidomycosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366790/
