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Organisms are inhaled and spread into the adjacent sinuses, eroding through the bone, sometimes presenting on the palate as a necrotic ulcer, a condition also referred to as rhinocerebral zygomycosis.29 Aspergillus infections are seen in neutropenic patients, especially those with leukemia and tend to present as necrotic soft tissue and bony lesions of the gingiva, while histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis are seen in areas where such infections are endemic such as in South America and in patients with HIV/AIDS.3033 Unlike candidiasis, deep fungal infections usually present as necrotic ulcers because they are angioinvasive organisms that cause vascular thrombosis and ischemia
