PRIMARY inoculation lesions can be caused by fungi that more commonly cause systemic mycotic disease. Such lesions have been shown with Coccidioides immitis1,2 and Blastomyces dermatitidis,3 among others. Reports also appear in the literature of primary or localized infections of Histoplasma capsulatum occurring in the vagina,4 eye,5 and oropharynx,6,7 as well as on the external cutaneous surface in accidentally infected laboratory personnel.8,9
A number of criteria have been proposed as critical in establishing the diagnosis of primary inoculation disease.9,10 Unfortunately, most of the suspected cases of such infection do not conform to all of these criteria; in particular, questions arise in regard to those cases allegedly involving the oropharynx.11 Most authors suggest that a case of proven histoplasmosis of the oral mucosa, despite an unusual appearance, should be regarded as an indication of systemic disease and approached as such therapeutically. We describe
Basler RSW, Friedman JL. Mucocutaneous Histoplasmosis. JAMA. 1974;230(10):1434–1435. doi:10.1001/jama.1974.03240100052030
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