Primary Cutaneous Histoplasmosis in an Immunocompetent Host from a Nonendemic Area

Abstract

A 32-year-old male presented to Dermatology outpatient Department with complaints of a single nonhealing ulcer on his right thigh. This lesion was there for the last 1΍ months. It had begun as a small nodule and increased up to the present size of 3 cm with an oozing and ulcerated surface and thickened everted margins. The systemic investigations were normal which included hemogram, biochemistry, including liver and renal function tests, chest X-ray, ultrasonography of abdomen, computed tomography of the thorax, and abdomen. Skin biopsy revealed multiple rounds to oval spores with surrounding halo intracellularly as well as extracellularly. A diagnosis of deep fungal infection as histoplasmosis was made and confirmed on culture.

Keywords: Fungus; histoplasmosis; immunocompetent.

Figure 1

Clinical photograph showing an ulcer on the right thigh

Figure 2

Photomicrograph showing sheets of macrophages with intracellular and extracellular small (2–3 μm) sized eosinophilic round to ovoid bodies. (HPE, ×1000)

Figure 3

Photomicrograph showing periodic acid Schiff positive magenta colored ovoid bodies. (PAS, ×1000)

Figure 4

Photomicrograph of culture on Sabaraud's dextrose agar showing whitish mycelial growth. The microscopic morphology of Histoplasma capsulatum at 25° centigrade shows tuberculate macroconidia (wall showing tiny spiny projections) (×400)