Multipronged Diagnostic Modalities Help to Crack a Case of Progressive Disseminated Histoplasmosis Presenting with Ambiguous Dermatological Lesions

Abid, Baazila; Ahmed, Jaweed; Saini, Vikas; Ghosh, Roumi; Malik, Sonia; Xess, Immaculata

doi:10.30491/hpr.2024.465683.1435

Multipronged Diagnostic Modalities Help to Crack a Case of Progressive Disseminated Histoplasmosis Presenting with Ambiguous Dermatological Lesions

Document Type : Case Report

Authors

Baazila Abid ¹

Jaweed Ahmed ¹

Vikas Saini ¹

Roumi Ghosh ¹

Sonia Malik ¹

Immaculata Xess ²

¹ Department of Microbiology, ESI-PGIMSR, Basaidarapur, New Delhi, India

² Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

https://doi.org/10.30491/hpr.2024.465683.1435

Abstract

Introduction: Histoplasmosis is a granulomatous fungal disease, caused by Histoplasma capsulatum; an intracellular dimorphic fungus, usually found in soil contaminated with bird and bat excreta; transmitted by aerosolized microconidia inhalation. The most common clinical presentation is acute or chronic Pulmonary Histoplasmosis.
Case Presentation: In this case report, a perplexing diagnostic scenario involving a 56-year-old patient who was HIV-negative but had diabetes mellitus and hypertension, in conjunction with unclear dermatological lesions has been presented. Despite treatment, the lesions did not respond favourably, posing a diagnostic dilemma. The identification of yeast forms in skin biopsy indicated progressive disseminated histoplasmosis, a diagnosis validated by PCR analysis, detection of Histoplasma galactomannan antigen in urine, and a positive fungal culture. A course of IV Liposomal Amphotericin B followed by oral Itraconazole, resulted in a favourable response.
Conclusion: Immunocompromised patients often exhibit mucocutaneous involvement, which is uncommon in immunocompetent individuals without specificity, leading to diagnostic difficulties. Although the patient lived in a non-endemic region, a travel history to Gangetic Plains, an endemic area for histoplasmosis, was elicited. Therefore, a comprehensive patient history is essential for diagnosis, in addition to microbiological and histopathological results.

Keywords

Histoplasmosis

Disseminated Histoplasmosis

Mucocutaneous Histoplasmosis

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