Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology

Translate this page into:
[gtranslate]

Case Report
2003:69:7;90-91

Disseminated histoplasmosis: cutneous presentation

SK Sayal, PS Prasad, A Mehta, S Sanghi
 Department of Dermatology and Venereology, Base Hospital, Delhi Cantt - 110010, India

Correspondence Address:
S K Sayal
Department of Dermatology and Venereology, Base Hospital, Delhi Cantt - 110010
India
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;69:90-91
Copyright: (C)2003 Indian Journal of Dermatology, Venereology, and Leprology

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.
Keywords: Disseminated histoplasmosis, Amphotericin, Ketoconazole

Introduction

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

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

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
1.
Listemann H, Meigel W.HIV associated mycosis. Mysocis 1995; 38:40-44.
[Google Scholar]
2.
Macdougall DS. Focus on fungal infections. J Int Assoc Physicians AIDS Care. 1997; 3:27-32.
[Google Scholar]
3.
Cockerell CJ. Cutaneous fungal infections in HIV/AIDS. J Int Assoc Physicians AIDS care. 1995; I:19-23.
[Google Scholar]
4.
Minamoto G Y, Rosenberg AS. Fungal Infections in patients with acquired immunoderficiency syndrome. Med Clin North Am 1997; 81;381-409.
[Google Scholar]
5.
Merger RD. Treatment of fungal infections in patients with HIV infection or AIDS. Zentralbl Bakteriol 1994; 281:1-7.
[Google Scholar]
Show Sections