A 57-year-old male patient was referred from the city of San Miguel de Tucumán, province of Tucumán.
He presented to the consultation for lesions in his tongue seven months old.
He was a smoker of 10 cigarettes a day.
Neurological examination was normal.
The results obtained from the biochemical tests (complete erythrocyte count, erythrosedimentation, glycaemia, alanine aminotransferase (ALT) and normal aminotransferase (AST) were normal.
HIV serology and tuberculin skin test were negative.
Chest radiography and magnetic resonance imaging of the neck were normal.
In the intraoral examination it was found that he was a partially dentate patient and that the remaining elements presented a marked attraction due to his bruxomania.
Examination of the tongue revealed a marked increase in volume, with erosive and bleeding lesions both at the tip and at the edges that were in close contact with the remaining elements.
These lesions resulted from an increase in the volume of the tongue that pressed against the tapered edges of these elements, which is why the elements were worn and polished.
The tongue also presented pseudoaneurysms that did not detach when passing a gauze.
The dorsum of the tongue presented nodular lesions separated in some sectors by deep grooves.
In a right and left lateral view, increased tongue volume in the anterior half was evident.
When the dorsum was identified, an increase in consistency (acarton-type) could be verified, recognizing perfectly formations in hemispheric subchorionic appearance, this maneuver showed no pain in the area.
Palatal attachment and floor of mouth revealed no alterations in consistency.
No lymphadenopathy was evident at submaxillary level.
A sample of the lingual edge was taken and sent for histopathological and microbiological examination.
Histopathology showed a tissue with granulomatous lesion, plasma and giant cells, exudate and associated ulcers.
Microbiological examination was negative.
Two weeks later a new biopsy was performed, this time of nodular lesions of the dorsum of the tongue, revealing a microgranuloma with multinucleated giant cells (Langhans type), without central necrosis.
The causative agent was not identified.
The patient returned to the clinic eight months later.
On examination, it was observed that the tongue doubled its volume with the appearance of two brushed languages, presenting difficulty in speaking.
The ventral dorsum showed a decrease in hardness of the lingual surface, but increased in its face.
There was no involvement of the floor of the mouth, but there were slightly painful submaxillary adenopathies.
Microbiological examination of the material obtained was requested. The Giemsa staining technique allowed the visualization of multiple yeasts 4-5 mm in diameter with a clear halo within macrophages and epithelial cells of the capsular phase.
The Act&apos;s colors were negative for cryptococcal meningitis, whereas the Act&apos;s mounting was negative for cryptococcal ink.
Serology using immunoelectrophoresis and counterimmunoelectrophoresis was positive for histoplasmin antigen.
These findings and the absence of systemic manifestations or other manifestations lead to the diagnosis of localized oral histoplasmosis.
He was referred to a public Infectious Diseases Department for treatment with itraconazole 200 mg/day with a regression of 40% of the lesion during the first month of treatment.
As ventral tricial sequels, she presented fibrous strands on her right and left sides.
