8 hours ago · A case of cutaneous histoplasmosis is reported in an 80-year-old man with rheumatoid arthritis who had been treated with steroid therapy for 15 years. The patient developed a large ulcerative lesion on the back of the left hand and on the distal third of the left … >> Go To The Portal
Histoplasmosis is a major cause of endemic mycosis worldwide. Immunosuppressed patients tend to present severe systemic disease. 1 We herein report a case of an immunocompromised patient with adult onset Still´s disease (AOSD) who, interestingly, developed a probable primary cutaneous histoplasmosis (PCH).
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Primary cutaneous histoplasmosis is rare in an immunocompetent individual more so from a non-endemic region. The skin lesions mostly are papulo-nodular. Histoplasmosis is a systemic mycosis. It is a deep fungal infection endemic in West Bengal and some areas of Southern India.[1]
Histoplasmosis is an opportunistic fungal infection occurring more commonly in immune-suppressed individuals. It has varied presentations, including pulmonary, progressive disseminated, chronic cavitary, and primary cutaneous forms.
After 6 months of therapy with itraconazol 300 mg daily, the skin ulcer healed. The patient has been monitored for about 18 months now, with no recurrence or other feature of histoplasmosis. Open in a separate window
Although Panja and Sen first reported histoplasmosis from India in 1959, case reports of the disease have been few and far between.[6] . Clinical manifestations of histoplasmosis are of three main types: Pulmonary, progressive disseminated, and chronic cavitary forms.[7] .
Discussion. Histoplasmosis is an endemic mycosis, which is most prevalent in the Ohio and Mississippi river valleys of North America though there are rare reports of this myoses from nonendemic regions too.[1,2] There are reports of this disease in both immuno-suppressed as well as immunocompetent host.[3] .
The clinical spectrum is variable, ranging from a severe multisystem illness involving the bone marrow, liver, spleen and lungs, to an indolent infection localized to the gastrointestinal tract, skin, adrenal glands, brain, meninges, or other extrapulmonary tissue. It has two variants: H. capsulatum var.
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.
The causative agent H. capsulatumis found globally in soil, especially in soil containing high concentrations of bird and bat droppings.[4] . It occurs mainly in immunocompromised individuals, more so in HIV-infected persons and usually with a CD4 counts <75 cells/μL.
It can present as a mucocutaneous lesion, pulmonary and as a generalized systemic infection. Histoplasmosis is frequently encountered in immunocompromised or patients on immunosuppressants.