Disseminated Histoplasmosis with Skin Lesions and Osteomyelitis in a Patient from the Philippines

Abstract

Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, is a disease of protean manifestations and of global distribution. Although increasingly reported in Asia, there are few reports from the Philippines. Here, we describe a case of microbiologically diagnosed histoplasmosis, probably acquired from the Philippines, in a returning traveler who presented with a right foot wound and papular rash. The final diagnosis was disseminated histoplasmosis with cutaneous and bone involvement, both unusual manifestations of the disease.

Figure 1.

(A) Right foot magnetic resonance image T1-weighted images show replacement of normal fatty signal in areas of second through fifth metatarsals and first through third cuneiform bones. (B) T2-weighted sequences show bone marrow edema in corresponding areas, consistent with osteomyelitis.

Figure 2.

Physical exam findings: (A) oblong nodular rash over left wrist, (B) scattered papular skin lesions, (C) some skin lesions were umbilicated (arrow), and (D) palatal lesions.

Figure 3.

Skin and bone pathology. (A) Low-power (original magnification ×100) examination of a hematoxylin and eosin (H&E)–stained skin biopsy specimen shows granulomatous inflammation of the dermis. (B) High-power magnification (original magnification ×400) of the same specimen stained by periodic acid–Schiff stain shows intracellular yeast forms within the dermis. (C) Low-power examination of an H&E-stained bone biopsy specimen demonstrates a predominantly neutrophilic infiltrate within bone architecture. (D) High-power magnification of the bone specimen stained by the Gomori methenamine silver stain reveals numerous intracellular and extracellular yeast cells, some of which exhibit narrow-based budding (arrow).