“The Great Pox of the Fungal World” Mucocutaneous histoplasmosis in a 57-year old HIV-negative Filipino male: A case report

Authors: Friend Philemon M. Liwanag, Maria Vinna N. Crisostomo, Michaela M. Tabalon, Mary Ann Sison, Lalaine R. Visitacion, Claribel L. Jimenez, and Maricarr Pamela M. Lacuesta-Gutierrez

Abstract

Introduction: Histoplasmosis is more widespread than once thought and its expanding global risk extends to Southeast Asia. Literature search reveals about a dozen reported cases of histoplasmosis among Filipinos. Protean clinical spectrum ranges from self-limited infection to progressive dissemination. Mucocutaneous histoplasmosis is frequently reported in patients with AIDS but a rare finding in immunocompetent hosts.

Case summary: A 57-year old male, smoker and drinker, sought consult for 9 months’ history of multiple skin-colored papules and nodules on the face, axillae and trunk associated with cough, anorexia and weight loss. He had no history of systemic diseases and denied exposure to bat or bird excreta. Cutaneous examination revealed multiple skin-colored papules and nodules, some with umbilication and ulceration, on the face, trunk, hands and axillae with erosions on the palate, tongue and buccal mucosa and negative lymphadenopathy. Hemogram demonstrated mild anemia. Blood chemistry was unremarkable. ESR, CRP and LDH were not elevated. HIV and VDRL tests were negative. Chest radiograph and sputum studies revealed pulmonary tuberculosis for which patient received quadruple regimen for 6 months. Histopathology showed dense dermal histiocytic infiltrates with numerous ovoid yeasts highlighted by Gomori Methenamine-Silver stain. Skin tissue cultures grew white cottony colonies with tuberculate macronidia at 250C and broad-based budding yeast colonies at 370C. Histoplasma capsulatum was validated by molecular detection. Oral itraconazole 200 mg twice daily for 12 months afforded resolution of lesions.

Conclusion: This report highlights judicious use of microbiological and molecular diagnoses with clinico-epidemio-pathologic correlation in placing the Philippine region in the map of histoplasmosis distribution.

 

Citation

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Keywords

histoplasmosis, Histoplasma capsulatum, dimorphism, fungal PCR, itraconazole

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