Granulomatous panniculitis in the setting of histoplasmosis in a patient with dermatomyositis on immunosuppressants

Abstract

This report describes a case of panniculitis in the setting of infection with histoplasma capsulatum in a patient with active dermatomyositis on immunosuppressive medications. The appearance of panniculitis on the patient’s lower extremity was interpreted as possible necrotizing cellulitis in the setting of the patient’s immunosuppressive therapy or worsening of her dermatomyositis rash. The patient was placed on multiple trials of empiric antibiotic therapy for over a month with no improvement of her plaques. The patient did not exhibit the typical clinical manifestations of histoplasmosis nevertheless, through further workup, including, histological studies and sterile tissue culture, the patient was ultimately found to be infected with H. capsulatum and initiated on antifungal therapy. The case emphasizes the importance of placing other uncommon infectious etiologies like histoplasmosis on the differential in myositis patients on immunosuppression therapy with atypical presentations. Timely consideration of such possibilities ensures that appropriate therapies are initiated without delay.