Oropharyngeal histoplasmosis.

Histoplasmosis, though usually a silent pulmonary infection, may progress to a severe, sometimes fatal disseminated infection. In the chronic form of disseminated histoplasmosis, granulomatous lesions of the upper aerodigestive tract are common. These lesions can be mistaken for carcinoma on initial presentation, as in the case we have presented here. The clinical course of patients with acute, subacute, or chronic disseminated forms of this disease correlates well with the histopathologic findings. Diagnosis is best made by culture or biopsy of a characteristic lesion. Although amphotericin B remains the standard treatment of disseminated histoplasmosis, the imidazole compounds such as ketoconazole, either alone or in combination with amphotericin B, have also been shown to be effective.