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Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients
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Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients

Published on: June 11, 2011

[Disseminated histoplasmosis: an atypical ulcerous form in an HIV-infected patient]

P Couppié1, M Roussel, N Thual

  • 1Service de Dermatologie, Centre Hospitalier de Cayenne, Guyane.

Annales De Dermatologie Et De Venereologie
|March 31, 2005
PubMed
Abstract

Insights

Disseminated histoplasmosis, a fungal infection common in AIDS patients, can present as rare, misleading skin ulcers. Early diagnosis through direct examination and culture is crucial for effective treatment.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Dermatology

Background:

  • Histoplasma capsulatum var capsulatum is a dimorphic fungus prevalent in the Americas.
  • Disseminated histoplasmosis is a significant opportunistic infection in individuals with Acquired Immunodeficiency Syndrome (AIDS).
  • Cutaneous ulcerations are an uncommon and diagnostically challenging presentation of disseminated histoplasmosis.

Observation:

  • A 25-year-old male with Human Immunodeficiency Virus (HIV) and a CD4+ count of 1/mm3 presented with fever and pulmonary symptoms.
  • The patient exhibited three distinct ulcerations (2-4 cm diameter) on his lower lip and knees.
  • Initial differential diagnosis included cutaneous leishmaniasis due to the ulcerative nature of the lesions.

Findings:

  • Diagnosis was confirmed by direct examination and culture of ulcer exudate and bronchoalveolar lavage fluid.
  • Histoplasmosis was identified as the causative agent, despite the atypical ulcerative presentation.
  • Cutaneous ulcerations are reported in less than 20% of disseminated histoplasmosis cases, which typically manifest as papular or nodular lesions.

Implications:

  • This case highlights the importance of considering histoplasmosis in the differential diagnosis of unusual cutaneous lesions, especially in immunocompromised patients.
  • Prompt mycological confirmation is essential for accurate diagnosis and timely management of disseminated fungal infections.
  • Awareness of atypical presentations can prevent misdiagnosis and improve patient outcomes in endemic regions.

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