DDx
Diagnostic Considerations
Also consider an underlying undiagnosed disorder leading to immunosuppression; dissemination of fungal infection; and extension into or invasion of the paranasal sinuses, the orbit, or the cranial cavity.
The condition may be indistinguishable from other causes of chronic oral ulceration, such as tuberculosis, malignancy, and any of the other deep mycoses.
Chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions, especially in patients who have traveled to endemic areas or are immunocompromised in any way, should be treated with suspicion.
Differential Diagnoses
Media Gallery
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Cryptococcosis. Left image shows solitary, destructive lesion resulting in necrosis of alveolar bone and palatal mucosa; note the superficial pseudomembranous candidiasis of the palate. Right image shows nonspecific chronic ulceration of the buccal mucosa due to cryptococcosis; this is associated with submucosal induration and regional adenopathy. Courtesy of David Sirois, DMD, PhD.
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Aspergillosis. Note deep mucosal ulceration and nodular expansion of the hard palate. Courtesy of David Sirois, DMD, PhD.
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Blastomycosis. Top image shows nonspecific papillary nodular lesion on the hard palate. Bottom image shows extensive ulceration involving the skin of the face and neck. Courtesy of David Sirois, DMD, PhD.
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Histoplasmosis. Top image shows periodontal recession and deep ulceration with exposed necrotic alveolar bone (arrow). Bottom image shows solitary, deep ulceration of the gingivae also associated with necrotic bone (arrow). Courtesy of David Sirois, DMD, PhD.
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Mucormycosis. Top left image shows multiple, deep ulcerations (arrows) of the hard palate. Top right image shows destruction of the palate and the floor of the orbit (failed skin graft of the right eye after orbital enucleation); this infection originated in the maxillary sinus. Bottom image shows similar deep, destructive ulceration of the left posterior maxillary alveolar bone and mucosa due to mucormycosis of the maxillary sinus. Courtesy of David Sirois, DMD, PhD.
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Rectangular conidia is observed (cotton blue 400x). Courtesy of Dr. Alexandro Bonifaz.
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Pseudomembranous form affecting the tongue. Courtesy of Dr. Alexandro Bonifaz.
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Culture of Geotrichum candidum on dextrose agar. Courtesy of Dr. Alexandro Bonifaz.
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