Authors:Frederica Veronica Marquez-Protacio MD
Introduction: Histoplasmosis is a granulomatous infection caused by the fungus, Histoplasma capsulatum. The disseminated type can be the initial manifestation of HIV/AIDS. It may affect the lungs, skin, gastrointestinal tract, liver, spleen, genitourinary tract, heart, bone marrow, adrenal glands, lymph nodes, and the central nervous system. Cutaneous findings are diverse and most present with few nodules and ulcerative lesions with involvement of the mucosal surface.
Case summary: This article describes the case of a 42-year-old male who presented fever, cough, oral ulcers, and multiple brownish nodular papules and plaques on the lips, face, trunk and extremities. Skin biopsy with tissue culture and sensitivity revealed Histoplasma capsulatum which was resistant to the recommended treatment, Amphotericin-B and Itraconazole. The patient was seropositive for HIV.
Conclusion: The incidence of HIV in the Philippines is rapidly increasing and we are expected to encounter more cases of opportunistic infections, such as in this case. Having a high index of clinical suspicion is important in establishing a diagnosis. In patients with HIV/AIDS or presumed to have AIDS presenting with multiple cutaneous lesions, skin biopsy for identification, culture, and sensitivity studies are valuable in determining the diagnosis and initiating treatment. Furthermore, the stigma of being diagnosed with HIV/AIDS prevents people from having HIV tests done. This causes delay in the diagnosis and treatment, and results in higher mortality. Public education and patient counseling are therefore vital in addressing the HIV epidemic.
Marquez-Protacio FV. Disseminated histoplasmosis in an HIV-positive Filipino. J Phil Dermatol Soc 2019, 28(1), 54-58
Histoplasma capsulatum, disseminated histoplasmosis, HIV, AIDS
Wheat J. Endemic mycoses in AIDS: a clinical review. ClinMicrobiol Rev. 1995;8(1):146–59.
Adenis AA, Aznar C, Couppié P. Histoplasmosis in HIV-Infected Patients: A Review of New Developments and RemainingGaps. Current Tropical Medicine Reports. 2014;1(2):119-128. doi:10.1007/s40475-014-0017-8.
Cohen, P. R., Grossman, M. E. and Silvers, D. N. DisseminatedHistoplasmosis and Human Immunodeficiency Virus Infection.International Journal of Dermatology, 1991;30:614–622.
Revised classification system for HIV infection and expandedsurveillance case definition for AIDS among adolescents andadults. Morbidity and Mortality Weekly Report, December 18,1992/41 (RR-17), 1993.
Nair S P, Vijayahdharan M, Vincent M. Primary CutaneousHistoplasmosis. Indian J Dermatol Venereol Leprol 2000;66:151-3.
Damasceno, L. S., Ramos, A. N., Alencar, C. H., Gonçalves, M. V. F., de Mesquita, J. R. L., Soares, A. T. D., Coutinho, A. G. N.,Dantas, C. C. and Leitão, T. d. M. J. S. Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil. Mycoses.2014;57: 406–413. doi:10.1111/myc.12175.
World Health Organization (2016). HIV and other sexuallytransmitted infections. Retrieved fromhttp://www.wpro.who.int/philippines/areas/communicable_diseases/hiv_aids/en/
Epidemiology Bureau, Department of Health (2017). NationalHIV/AIDS & STI Surveillance and Strategic Information Unit(NHSSS).Retrievedfromhttp://www.doh.gov.ph/stat_of_the_month
Bonifaz, A., Cansela, R., Novales, J., De Oca, G. M., Navarrete, G.and Romo, J., Cutaneous histoplasmosis associated withacquired immunodeficiency syndrome (AIDS). InternationalJournal of Dermatology. 2000;39:35–38.
Bulmer AC, Bulmer GS. Incidence of histoplasminhypersensitivity in thePhilippines. Mycopathologia. 2001;149(2):69–71. doi:10.1023/A:1007277602576.
A. Chakrabarti, M. A. Slavin; Endemic fungal infections in theAsia-Pacific region. Medical Mycology. 2011;49(4):337–344.
Kauffman CA. Histoplasmosis: a clinical and laboratoryupdate. Clin Microbiol Rev. 2007;20(1):115–32. doi:10.1128/CMR.00027-06.
Kauffman CA. Histoplasmosis: a Clinical and LaboratoryUpdate. Clinical Microbiology Reviews. 2007;20(1):115-132.doi:10.1128/CMR.00027-06.
K. Ramdial, P., Mosam, A., Dlova, N. C., B. Satar, N., Aboobaker, J.and Singh, S. M. (2002), Disseminated cutaneoushistoplasmosis in patients infected with humanimmunodeficiency virus. Journal of Cutaneous Pathology, 29:215–225. doi:10.1034/j.1600-0560.2002.290404.x
Johnson PC, Khardor N, Najjar AF, et al, Progressivedisseminated histoplasmosis in patients with acquiredimmunodeficiency syndrome, Am J Med. 1988;85:152-158.
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