Disseminated histoplasmosis in a 53-year-old HIV-negative Filipino male: A case report
- Author:
Dana Andrea D. Nery, MD
1
;
Maria Katherina Lat-Herrin, MD, FPDS, FDSP-PDS
1
;
Mary Elizabeth Danga, MD, FPDS, FDSP-PDS
1
Author Information
- Publication Type:Case Reports
- Keywords: molluscum-like lesions
- MeSH: systemic fungal infections; disseminated histoplasmosis; itraconazole
- From: Journal of the Philippine Dermatological Society 2023;32(1):47-52
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Histoplasmosis is a disease of global distribution with diverse manifestations caused by the dimorphic fungus Histoplasma capsulatum. It is frequently described in severely immunocompromised and Human Immunodeficiency Virus (HIV)-positive
individuals. Despite being widely reported in Southeast Asia, few cases have been reported in the Philippines.
Case Report:A 53-year-old Filipino male who presented with umbilicated papules resembling molluscum contagiosum, and a previous history of a left lung mass with initial complaints of cough and hemoptysis. Gram stain of his sputum revealed the presence of fungal elements, otherwise not specified. In relation to this, a fine-needle aspiration biopsy of the suspected lung mass was done. However, findings were negative for malignant cells and fungi. Dermoscopy revealed central ulceration and necrosis with faint peripheral arborizing telangiectasia and surrounding superficial scaling. Histopathologic analysis revealed a diffuse granulomatous dermatitis, and Periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) stains showed numerous small yeast-like structures measuring approximately 3.74µm in diameter. Tissue culture of the skin lesion on the right thigh isolated fungal elements but was not specified. As histoplasmosis is an AIDS-defining infection and often found in immunocompromised states, screening for HIV was done which revealed negative results. Interestingly, disease distribution of histoplasmosis in the Philippines was frequently found in HIV-negative patients. Due to persistent serum creatinine elevation of over 300 µmol/L, renal biopsy was also done and revealed similar fungal elements. With these findings, a diagnosis of disseminated histoplasmosis was made. After a month of treatment with oral itraconazole, there was marked improvement of the patient’s skin lesions.
Conclusion:This case highlights the importance of recognizing cutaneous manifestations and maintaining a high index of suspicion for histoplasmosis in HIV-seronegative patients. - Full text:JPDS 10.pdf
