Disseminated histoplasmosis and necrotizing vasculitis

Area of Science:

• Mycology
• Infectious Diseases
• Dermatology

Background:

• Disseminated histoplasmosis is a serious fungal infection, primarily affecting immunocompromised individuals.
• Skin manifestations in disseminated histoplasmosis are uncommon, with necrotizing vasculitis being exceptionally rare.

Purpose of the Study:

• To report a rare case of disseminated histoplasmosis presenting with necrotizing vasculitis.
• To highlight diagnostic and therapeutic challenges in managing disseminated fungal infections with cutaneous involvement.

Main Methods:

• Case report of a 74-year-old male with congestive heart failure.
• Initial diagnosis of Histoplasma capsulatum in nasal septum lesion.
• Treatment with amphotericin B, complicated by intolerance.
• Detection of H. capsulatum in blood and bone marrow.
• Biopsy-confirmed necrotizing vasculitis in purpuric skin lesions.
• Treatment with transfer factor for cutaneous anergy.

Main Results:

• The patient presented with H. capsulatum in a nasal lesion, later progressing to disseminated disease.
• Initial amphotericin B treatment was poorly tolerated.
• Disseminated infection was confirmed by positive blood and bone marrow cultures.
• Purpuric skin lesions exhibited necrotizing vasculitis.
• Cutaneous anergy resolved following transfer factor administration.

Conclusions:

• This case underscores the unusual presentation of disseminated histoplasmosis with necrotizing vasculitis.
• Management requires addressing both systemic fungal infection and severe cutaneous manifestations.
• The reversal of cutaneous anergy with transfer factor suggests a potential role in modulating immune response.