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Year : 2020  |  Volume : 65  |  Issue : 6  |  Page : 552-554
Disseminated histoplasmosis with oral and cutaneous manifestations in an immunocompetent patient


Department of Dermatology, IPGME&R, Kolkata, West Bengal, India

Date of Web Publication23-Oct-2020

Correspondence Address:
Arpita Hati
Department of Dermatology, IPGME&R, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_426_19

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How to cite this article:
Sen S, Hati A, Mallick S, Das S. Disseminated histoplasmosis with oral and cutaneous manifestations in an immunocompetent patient. Indian J Dermatol 2020;65:552-4

How to cite this URL:
Sen S, Hati A, Mallick S, Das S. Disseminated histoplasmosis with oral and cutaneous manifestations in an immunocompetent patient. Indian J Dermatol [serial online] 2020 [cited 2020 Dec 4];65:552-4. Available from: https://www.e-ijd.org/text.asp?2020/65/6/552/298917




Sir

A 38-year-old Indian man, farmer by profession was admitted with fever, shortness of breath, and weight loss present for past 3 months. Umbilicated skin-colored papules were observed on face trunk and extremities for last 2 months [Figure 1]. Patient had no history of tuberculosis or malignancy. Ulceration over dorsum of tongue and vegetative nodular lesion on the palate were causing distress to the patient [Figure 2]. Physical examination revealed cervical and inguinal lymphadenopathy and hepatosplenomegaly.
Figure 1: Umbilicated papules over trunk, face, and extremities

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Figure 2: Vegetative nodules over palate and ulcer over dorsum of tongue

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Laboratory workup revealed moderate anemia (8.3 mg/dL). Serology tests for HIV-1 and 2 and Hepatitis B, Hepatitis C were nonreactive. Blood VDRL test was also nonreactive. Sputum for acid-fast bacilli was negative. Skin biopsy showed small oval-shaped yeast-like bodies, morphologically resembling Histoplasma capsulatum , present within histiocytes [Figure 3]. Giemsa stain of umbilicated papule did not reveal molluscum bodies. Lymph node biopsy showed foamy histiocytes filled with many yeast form of fungus with central dark oval body and peripheral halo. Patient was started on intravenous lysosomal amphotericin B and this was continued for 15 days. Itraconazole 200 mg twice daily was initiated after this period and patient started improving soon after starting itraconazole. He continued to remain well and was on itraconazole till reporting six month after initiation.
Figure 3: Histopathology shows histiocytes filled with small ovoid bodies surrounded by clear halo (H and E, ×400). Special stain shows spores of Histoplasma capsulatum (GMS stain, ×400)

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Histoplasmosis is a systemic fungal infection caused by the dimorphic fungus Histoplasma capsulatum . Activities that disturb the soil and bird droppings like excavation and construction work in endemic region expose an individual to the spores of the fungus (microconidia).[1] Disseminated form of the disease has been observed mainly in patients with AIDS, in infants, elderly or immunocompromised. Occurrence of disseminated histoplasmosis is very rare among the HIV seronegatives.[2] However, our patient was middle aged and immunocompetent.

The involvement of two or more sites by the fungus qualifies a case to be disseminated histoplasmosis. Our patient had involvement of the oral mucosa, skin, and lymph nodes. Oral lesions can exhibit various forms, such as ulcers, erythematous, or vegetative nodules and even warty growths. The palate, gingiva, and oropharynx are the most frequent sites of oral involvement.[3] This disseminated form of histoplasmosis is uncommon in India. Less than 200 cases have been reported[4] and disseminated histoplasmosis with oral involvement in an immunocompetent person has rarely been described in the literature.[5]

Histoplasmosis should be considered in the differential diagnosis of patients presenting with extensive umbilicated lesions, not conforming to the diagnosis of molluscum contagiosum even in immunocompetent persons. Early diagnosis and urgent initiation of treatment may go a long way in healing such a patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kauffman CA. Histoplasmosis: A clinical and laboratory update. Clin Microbiol Rev 2007;20:115-32.  Back to cited text no. 1
    
2.
Vidyanath S, Shameena PM, Sudha S, Nair RG. Disseminated histoplasmosis with oral and cutaneous manifestations. J Oral Maxillofac Pathol 2013;17:139-42.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Harnalikar M, Kharkar V, Khopkar U. Disseminated cutaneous histoplasmosis in an immunocompetent adult. Indian J Dermatol 2012;57:206-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Bauddha NK, Jadon RS, Mondal S, Vikram NK, Sood R. Progressive disseminated histoplasmosis in an immunocompetent adult: A case report. Intractable Rare Dis Res 2018;7:126-9.  Back to cited text no. 4
    
5.
Mignogna MM, Fedele SS, Lo Russo L, Ruppo EE, Lo Muzio L. A case of oral localized histoplasmosis in an immunocompetent patient. Eur J Clin Microbiol Infect Dis 2001;20:753-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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