Buccal ulceration as an initial presentation of disseminated histoplasmosis, complicated by haemophagocytic lymphohistiocytosis

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum . Immunosuppression can result in disseminated infection with high mortality. We describe a patient from Ghana with advanced HIV who presented with a buccal ulcer. He was diagnosed with disseminated histoplasmosis with oral, lymph node, pulmonary, adrenal and central nervous system involvement and subsequently developed haemophagocytic lymphohistiocytosis. The last travel to an endemic region was nine years beforehand, so that and prolonged travel history is often required in the case of significant immunosuppression.