IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 2011 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  
  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    References

 Article Access Statistics
    Viewed4174    
    Printed80    
    Emailed2    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 
CASE REPORT
Year : 2003  |  Volume : 69  |  Issue : 7  |  Page : 90-91

Disseminated histoplasmosis: cutneous presentation


Department of Dermatology and Venereology, Base Hospital, Delhi Cantt - 110010

Correspondence Address:
Department of Dermatology and Venereology, Base Hospital, Delhi Cantt - 110010

   Abstract 

A 37-year-old man presented with fever, loss of weitht and multiple raised skin lesions on face, neck and hands of 3 months duration. Skin biopsy and bone marrow aspirate revealed PAS posittive intracellular organism. He was treated with Amphotericin and Ketoconazole with excellent response.

How to cite this article:
Sayal S K, Prasad P S, Mehta A, Sanghi S. Disseminated histoplasmosis: cutneous presentation. Indian J Dermatol Venereol Leprol 2003;69, Suppl S1:90-1


How to cite this URL:
Sayal S K, Prasad P S, Mehta A, Sanghi S. Disseminated histoplasmosis: cutneous presentation. Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2019 Jun 26];69, Suppl S1:90-1. Available from: http://www.ijdvl.com/text.asp?2003/69/7/90/5874



   Introduction Top

Histoplasmosis is caused by spores of the dimorphic fungus Histoplasma capsulatum. Most cases are mild or asymptomatic. It can occur as Acute or progressive disorder, disseminated disease or as a chronic disorder. Skin lesions may occur with all the three form or rarely as primary cutaneous histoplasmosis. The disseminated disease commonly occur in persons with Immunocompromised state such as AIDS and is often rapidly fatal. The incidence and severity of fungal infection appears to increase with progression of HIV infection.[3]
We are reporting a case of disseminated histoplasmosis in a HIV positive individual presented in cutaneous form treated with amphotericin and ketoconazole with excellent response.

   Case Report Top

A 37-year-old patient reported with complaints of multiple raised skin lesions on face, neck and hands of 2-3 months duration. History of fever and loss of weight was also present. General examination revealed undernourished, ill looking cachectic individual with gross pallor and significant generalised lymphadenopathy. Dermatological examination revealed multiple papules and nodules, distributed on face, neck, shoulders and dorsum of both hands [Figure - 1]. Few lesions showed cheesy exudate and purulent discharge also. Abdominal examination revealed hepatosplenomegaly. Respiratory system examination was essentially normal.
On investigation, he was found to be HIV positive by ELISA method and confirmed by western blot. Skin biopsy revealed granulomatous changes and fibrosis in dermis with masses of fungal cells [Figure - 2]. Bone morrow aspirate revealed PAS positive intracellular organisms. He was diagnosed as a case of Disseminated histoplasmosis and treated with Amphotericin in dosage of 0.5 mg/kg/day for 4 weeks and Ketoconazole 200 mg twice a day for 3 months with excellent response. He was continued with ketoconozole 200 mg/d fro another one year to prevent relapse.


   Discussion Top

Cutaneous lesions in cases of disseminated histoplasmosis can be papule, pustule or plaque, ulcers, wart like and rarely may present as erythema nodosum. In AIDS patients the skin involvement in histoplasmosis should always be included in the differential diagnosis specially in patients with face and trunk papules associated with fever and hepatosplenomegaly. Skin and bone marrow cultures are the most reliable diagnostic methods.[4] The various drugs employed in treatment of hisoplasmosis are amphotericin, Ketoconazole, itraconazole and terbinafine. Itraconazole is the drug of choice for histoplasmosis.[5] Disseminated histoplasmosis in immunocompromised host go a poor prognosis. For disseminated fungal infections, suppressive therapy must be continued to prevent relapse. In the case ketoconazole was continued in low dose of 200mg OD for one year. The clinical evolution of the disease was wxceptional in this case, with disappearance of all skin lesions after the treatment with no evidence of relapse after one year. 

   References Top

1.Listemann H, Meigel W.HIV associated mycosis. Mysocis 1995; 38:40-44.  Back to cited text no. 1    
2.Macdougall DS. Focus on fungal infections. J Int Assoc Physicians AIDS Care. 1997; 3:27-32.  Back to cited text no. 2    
3.Cockerell CJ. Cutaneous fungal infections in HIV/AIDS. J Int Assoc Physicians AIDS care. 1995; I:19-23.  Back to cited text no. 3    
4.Minamoto G Y, Rosenberg AS. Fungal Infections in patients with acquired immunoderficiency syndrome. Med Clin North Am 1997; 81;381-409.  Back to cited text no. 4    
5.Merger RD. Treatment of fungal infections in patients with HIV infection or AIDS. Zentralbl Bakteriol 1994; 281:1-7.  Back to cited text no. 5    

 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow