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

Workup

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Media Gallery

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.
Aspergillosis. Note deep mucosal ulceration and nodular expansion of the hard palate. Courtesy of David Sirois, DMD, PhD.
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.
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.
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.
Rectangular conidia is observed (cotton blue 400x). Courtesy of Dr. Alexandro Bonifaz.
Pseudomembranous form affecting the tongue. Courtesy of Dr. Alexandro Bonifaz.
Culture of Geotrichum candidum on dextrose agar. Courtesy of Dr. Alexandro Bonifaz.

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Author

Manuel Valdebran, MD Junior Specialist Physician, Visiting Scholar in Dermatology/Dermatopathology, Department of Dermatology, University of California, Irvine, School of Medicine

Manuel Valdebran, MD is a member of the following medical societies: International Dermoscopy Society, Medical Dermatology Society, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Janellen Smith, MD Health Sciences Clinical Professor, Department of Dermatology, Co-Director of Pigmented Lesion Program, University of California, Irvine, School of Medicine; Staff MD, Dermatology Service, Long Beach VA Medical Center

Janellen Smith, MD is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, California Society of Dermatology and Dermatologic Surgery, Dermatologic Society of Orange County, Dermatology Foundation, Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Shyam Verma, MBBS, DVD, FAAD Clinical Associate Professor, Department of Dermatology, University of Virginia School of Medicine; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook School of Medicine; Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Oslei paes de Almeida, PhD; Maria Regina Sposto, DDS, PhD, MDSc, Associate Professor, Department of Oral Surgery, Faculdade de Odontologia de Araraquara; Consulting Staff, Department of Oral Diagnosis and Surgery, Faculdade de Odontologia de Araraquara, Brazil

Disclosure: Nothing to disclose.

Maria Regina Sposto, DDS, PhD, MDSc(Dental Science), PhD(Dentistry) Associate Professor of Oral Diagnosis and Oral Medicine, Consulting Staff, Department of Oral Surgery and Diagnosis, Faculdade de Odontologia de Araraquara, UNESP-Universidade Estadual Paulista, Brazil

Disclosure: Nothing to disclose.