Cutaneous Histoplasmosis Research Articles

Primary cutaneous histoplasmosis in a skin scrape cytology

Histoplasmosis refers to an infection caused by histoplasma capsulatum, a dimorphic fungus. We report a rare case of cutaneous histoplasmosis in an immunocompromised patient. The diagnosis was made by the cytopathologic examination of skin scraping smear, which showed numerous intracellular and extracellular periodic acid-schiff positive rounded yeast cells. The patient showed dramatic response with itraconazole and amphotericin B. We opine that skin scrape cytology can be useful in establishing the diagnosis of the disease, specially when the other facilities are not readily available.

Immune Reconstitution Inflammatory Syndrome: Cutaneous and Bone Histoplasmosis Mimicking Leprosy after Treatment

We present a case of disseminated histoplasmosis in a 12-year-old HIV infected boy. This is a rare presentation of Histoplasma capsulatum var. capsulatum which presented as Immune Reconstitution Inflammatory Syndrome with osteoarticular involvement. He was treated with fluconazole for five years and healed with shortening of all the digits.

Syphilis of fungal world: Novel skin manifestations of histoplasmosis in an immunocompetent host

A case of chronic disseminated cutaneous histoplasmosis with unusual skin manifestations in an immunocompetent host is reported. Presence of cutaneous ulcers, linear erythematous plaques, skin coloured atrophic plaques and recurrent self-limiting oral ulcers in a single patient has not been documented in literature so far. Diagnosis was established by identifying small intracellular yeast-like cells of Histoplasma in tissue smear and skin biopsy. Leishman stained tissue smear proves to be an easy and simple procedure for diagnosis of histoplasmosis.

An unusual clinical and histologic presentation of disseminated cutaneous histoplasmosis

To the Editor: Histoplasmosis, an infection with the dimorphic saprophytic fungus Histoplasma capsulatum var capsulatum, occurs by either inhalation or direct cutaneous inoculation. It is the most common endemic mycosis in immunosuppressed patients, and disseminated infection in this population may lead to septic shock with multiorgan failure.1 Cutaneous involvement occurs in 5% to 20% of cases of disseminated histoplasmosis, and most commonly presents as papules that favor the face and chest.2-4 Other manifestations include ulcerating plaques, vesicles and pustules, pyoderma gangrenosum–like ulcers, and exanthematous eruptions.

Cytodiagnosis of cutaneous histoplasmosis in HIV positive patient initially presenting with multiple umbilicated disseminated skin nodules

Histoplasmosis is usually an opportunistic fungal infection in patients with defective cell mediated immunity, and has been considered as one of the acquired immunodeficiency syndrome (AIDS) defining illness. However, cutaneous involvement in human immunodeficiency virus (HIV) positive patients is less common, and very rarely can be the initial presenting symptom for the diagnosis of AIDS. We present here an unusual case of multiple diffuse cutaneous nodular lesions predominantly in face, trunk, and upper extremities diagnosed initially on aspiration cytology as histoplasmosis. Subsequent serological test revealed positivity for HIV 1 and 2, along with a low CD4 count and low CD4:CD3 ratio. The cytomorphological features were further corroborated by histology and histochemical stains. Hence, cutaneous histoplasmosis can cause multiple wide spread nodular or umbilicated lesions in AIDS patients as the initial presentation. Fine needle aspiration cytology (FNAC) is a rapid, cost effective tool for diagnosis of the fungi from such lesions and initiating work up for immunocompromised states including AIDS.

Síndrome de restauração imune associada à histoplasmose

A 27-year-old HIV-positive male patient with disseminated cutaneous histoplasmosis was treated with both HAART and amphotericin B (total accumulated dose of 0.5 g). Amphotericin B was later replaced with itraconazole (200mg/day). Two months after therapy had been started and the cutaneous lesions had healed, the patient interrupted both treatments voluntarily and his health deteriorated. HAART was then re-introduced and CD4+ cell count increased sharply at the same time as lymph node histoplasmosis was diagnosed. This paradoxical response? the relapse of histoplasmosis and concomitant increase in CD4+ cell count and undetectable viral load after resumption of HAART ? suggests that this was a case of immune reconstitution inflammatory syndrome (IRIS).

Probable primary cutaneous histoplasmosis in a patient infected with HIV

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. Most infections occur after inhalation of fungal spores. A wide variety of clinical manifestations can occur depending on the host response and the extent of inoculation. We report a case of probable cutaneous histoplasmosis after trauma in a 26-year-old man from Paraguay who was also infected with the human immunodeficiency virus. Diagnosis was based on histological and mycological examination. No systemic involvement was found.

A case of primary cutaneous histoplasmosis acquired in the laboratory

A case of primary cutaneous histoplasmosis acquired in the laboratory

Histoplasmosis Presenting as a Cutaneous Malignancy of the Eyelid

Cutaneous histoplasmosis is an uncommon infection and can occur as a primary infection. A manifestation imitating a cutaneous neoplasm is rare, and eyelid involvement is rarer still. The authors report a case of histoplasmosis that presented as an ulcerated lesion on the lower eyelid margin that clinically resembled a basal cell carcinoma. Given its worldwide distribution, it is important to include this disease in the differential diagnosis of nonhealing eyelid lesions. Biopsy and tissue culture are paramount to establishing the diagnosis. This case describes a rare presentation of histoplasmosis on the eyelid and highlights the importance of histopathologic evaluation.

Disseminated cutaneous histoplasmosis in a patient infected with HIV

Disseminated cutaneous histoplasmosis in a patient infected with HIV

Transmission electron microscopy for the definitive diagnosis of disseminated cutaneous histoplasmosis

Transmission electron microscopy for the definitive diagnosis of disseminated cutaneous histoplasmosis

Cutaneous Histoplasmosis in Dogs

Cutaneous Histoplasmosis in Dogs

Disseminated Cutaneous Histoplasmosis in an Immunocompetent Child, Relapsed with Itraconazole, Successfully Treated with Voriconazole

We present a rare case of disseminated cutaneous histoplasmosis in an immunocompetent child who relapsed after treatment with amphotericin B followed by itraconazole and was successfully treated with voriconazole.

Primary cutaneous histoplasmosis in a HIV-positive individual

A 31-year-old human immunodeficiency virus-positive male who presented to the Dermatology Outpatient Department with complaints of red, raised lesions on the face of 2 weeks duration was, on examination, found to have multiple papulonodular lesions on the face with associated cervical and axillary lymphadenopathy. There was history of local injury on the face 6 months prior to the development of symptoms. Skin biopsy revealed multiple round to oval spores with surrounding halo intracellularly, confirming the diagnosis of cutaneous histoplasmosis. No systemic involvement was detected on further investigations. The patient responded to oral antifungals in a short duration, confirming the local nature of the presentation. This is probably the first time in the literature that a primary cutaneous manifestation of histoplasmosis is being described in an immunocompromised individual.

Cutaneous histoplasmosis as initial presentation of AIDS

Cutaneous histoplasmosis as initial presentation of AIDS

Primary cutaneous histoplasmosis*

Summary Biopsy of a swollen, painful, right inguinal lymph node of a 15-year-old boy revealed histoplasmic lymphadenitis. Histoplasmic granulomas were also observed at biopsy of right plantar skin ulcer, thought traumatic in origin. The patient was asymptomatic and had a normal chest x-ray. The subject of primary inoculation of mucocutaneous histoplasmosis is being reviewed. Four previous cases with bona fide extra pulmonary primary mucocutaneous histoplasmosis with a benign course have been reported. Zusammenfassung Die Biopsie eines geschwollenen und schmerzhaften rechtsseitigen Leistenlymphknotens eines 15 Jahre alten Jungen ergab eine histoplasmotische Lymphadenitis. Als daraufhin die Probeexcision von einem vermutlich traumatischen Hautulkus an der rechten Fussohle untersucht wurde, fanden sich auch histoplasmotische Granulome. Der Patient war asymptomatisch und hatte ein normales Rontgenbild der Lungen. Nur vier „bona fide”-Falle von primarer mucokutaner Histoplasmose sind bisher mitgeteilt worden.

Mucocutaneous histoplasmosis in HIV with an atypical ecthyma like presentation

Pulmonary and disseminated forms of histoplasmosis are very common in AIDS, but primary cutaneous histoplasmosis is rare. We report a case of primary mucocutaneous histoplasmosis in the setting of HIV.

Histoplasmose cutânea primária: relato de caso em paciente imunocompetente e revisão de literatura

This report describes a case of primary cutaneous histoplasmosis in a 45-year-old male. The presentation consisted of an erythematous nodule on the back of the right hand, accompanied by nontender regional lymphadenomegaly that developed following local trauma that occurred during military training in a tunnel inhabited by bats. Histological examination of a biopsy specimen from the skin lesion showed granulomatous infiltrate, but did not show fungal elements. Culturing of this material, incubated in Sabouraud agar, showed growth of Histoplasma capsulatum. No evidence of systemic involvement or immunosuppression was found. Treatment with 400 mg/day of itraconazole orally for six months resulted in complete remission of the lesion, which was maintained one year after the end of the treatment.

Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: report of 23 cases

Disseminated cutaneous histoplasmosis is an opportunistic infection in patients with acquired immunodeficiency syndrome. We report a series of 23 cases (21 men, two women; median age 29 years) with disseminated cutaneous histoplasmosis seen at two hospital centres. Most of the patients (21/23) were classified as stage C3. The most common dermatological findings were papules, crusting plaques, nodules and ulcers, mainly located on the face and chest. Of the 23 cases, 15 (65%) had pulmonary involvement. Amphotericin B and itraconazole were the main drugs used for treatment. Treatment response was variable: four of the patients were cured, six improved and remain stable, nine patients died, and four patients were lost to follow-up.

Chronic disseminated cutaneous histoplasmosis in an immunocompetent individual – a case report

A 45-year-old woman from central India reported to clinic with multiple swellings on the face and neck. She had red patches on her forearms and trunk, but there was a predominance of lesions on the face and neck. On examination, her face showed multiple, succulent, erythematous plaques which were mildly pruritic (Fig. 1). There was no discharge. There were also some scattered erythematous papules and nodules on the face (Fig. 1). Examination of the neck revealed multiple erythematous plaques, many of them with a linear orientation and central ulceration and crusting (Fig. 2). The upper extremities showed multiple erythematous plaques, most of which were ulcerated (Fig. 3). Plaques without ulceration had been present for the past 2 years. The patient had been treated in various centers around her village and in Baroda as a case of reactional leprosy. Figure 1Open in figure viewerPowerPoint Multiple, succulent, erythematous plaques, papules, and nodules on the face Figure 2Open in figure viewerPowerPoint Linear orientation of plaques on the neck with superficial ulceration Figure 3Open in figure viewerPowerPoint Ulcerated plaques on the forearms with purulent discharge and crusting The patient was apparently in good health and was a farmer living in a rural area. She had no other complaints. She was afebrile. There was no anesthesia. No nerves were palpable. There were no palpable lymph nodes. Her spleen and liver were not palpable. The mucosae appeared normal, but she complained of recurrent superficial ulceration, which resolved spontaneously. There was no cough. There were no joint pains. She had a steady weight. Her vital signs were normal. Routine investigations revealed a hemoglobin of 10 g%, an erythrocyte sedimentation rate (ESR) of 30 mm/h, and mildly elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT). X-Ray of the chest showed mild widening of the superior mediastinum with a right paratracheal lobular shadow, signifying right paratracheal lymphadenopathy. Ultrasonography (USG) showed mild splenomegaly with enlarged pre- and para-aortic nodes. Computed tomography (CT) scan of the chest and abdomen revealed paratracheal, mediastinal, and pre- and para-aortic lymphadenopathy, mild splenomegaly, and a horseshoe kidney. There was nothing suggestive of any overt immune suppression, namely leukemia, lymphoma, cancer, human immunodeficiency virus (HIV), or any collagen vascular disorders. Her CD4 count was normal at 581/µL (range, 290–2600/µL). Diabetes, which could have been the cause of the immune suppression, was found only later during the course of treatment and is now under control with oral hypoglycemic agents. Her renal profile was normal. She had no central nervous system (CNS) signs or symptoms. Skin biopsy was performed from two plaques. It showed a granulomatous infiltrate in the dermis with numerous parasitized macrophages. The macrophages contained small round to ovoid yeast-like organisms with a surrounding clear halo (Fig. 4). Lymphocytes, plasma cells, etc. were very few in number. The picture was essentially dominated by parasitized macrophages. The overlying epidermis was unremarkable. A diagnosis of histoplasmosis was made. Additional stains, including periodic acid–Schiff (PAS) and silver methanamine, were found to be positive at an advanced dermatology department in New Delhi, substantiating the diagnosis of cutaneous histoplasmosis. Figure 4Open in figure viewerPowerPoint Macrophages containing multiple yeast-like organisms with surrounding clear halo (hematoxylin and eosin, ×10) Whilst awaiting the confirmation of the diagnosis, the patient was empirically given itraconazole 200 mg twice daily, and she has now been on the drug for the past 6 months. On her first follow-up, her lesions were slightly flattened, but distinctly scaly, unlike the initial appearance. She reported subjective improvement. Fifteen days later the patient reported with severe erythema and a flare up of the plaques and nodules on the face and neck. All the plaques were very scaly. The lesions on her arms were ulcerated. Hypersensitivity to destruction of the organisms was suspected and she was given 40 mg of triamcinolone acetonide intramuscularly. She telephoned in to say that she was much better on the 10th day. Six weeks after the telephone call she was seen again and her lesions showed remarkable improvement. All the lesions had dried up and the plaques and nodules had flattened dramatically (5, 6). There was no scaling. The erythema was markedly reduced. Her lesions had almost disappeared at the third monthly follow-up (5, 6). The patient was feeling well. The patient continues on itraconazole, now at a dose of 100 mg twice daily. Her laboratory parameters are normal. Her hemoglobin has improved to 12 g%. Her ALT and AST values remain unchanged. Figure 5Open in figure viewerPowerPoint Healed lesions of the face and neck 3 months after treatment with itraconazole Figure 6Open in figure viewerPowerPoint Complete healing of the ulcerated, crusted lesions of the forearms 3 months after treatment with itraconazole