Primary Cutaneous Histoplasmosis in a HIV-Positive Individual

Abstract

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.

Keywords: Fungus; Histoplasmosis; Human immunodeficiency virus; Itraconazole.

Figure 1

Nodules and plaques on the face with few pearly-white lesions around the eyes

Figure 2

Skin biopsy showing thinned-out epidermis with multiple dermal granulomas comprising of lymphocytes, histiocytes and plasma cells (Hematoxylin and eosin stain–10×)

Figure 3

Higher magnification showing clusters of round fungal spores intracellularly (Hematoxylin and eosin stain–40×)

Figure 4

Oil immersion photomicrograph depicting halos around the intracellular spores (Hematoxylin and eosin stain–100×)

Figure 5

X-ray of the skull showing persisting splinter in the frontal area

Figure 6

Complete regression of histoplasmosis lesions after treatment, with persisting molluscum lesions