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Imaging CD4 T Cell Interstitial Migration in the Inflamed Dermis

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Histoplasma panniculitis in dermatomyositis.

J W Huston¹, P C McNabb, J P Frias

¹Department of Medicine, Baptist Hospital and the University of Tennessee Center for Health Sciences and Vanderbilt University, Nashville, Tennessee.

Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases

|December 17, 2008

Summary

Histoplasmosis can cause infectious panniculitis in dermatomyositis patients, mimicking disease flares. Early diagnosis and treatment with antifungals are crucial for recovery.

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Area of Science:

Infectious Diseases
Dermatology
Rheumatology

Background:

Dermatomyositis is an autoimmune disease affecting muscles and skin.
Histoplasmosis is a fungal infection, typically affecting the lungs.

Purpose of the Study:

To describe the coexistence of infectious panniculitis caused by Histoplasma capsulatum in patients with dermatomyositis.
To highlight the diagnostic challenges and emphasize the importance of considering histoplasmosis in the differential diagnosis.

Main Methods:

Case series of three patients with dermatomyositis presenting with panniculitis.
Clinical evaluation, diagnostic procedures including biopsies, and treatment response assessment.

Main Results:

Panniculitis was the primary manifestation of histoplasmosis in all three patients.
Disseminated histoplasmosis features were absent, potentially delaying diagnosis.
Antifungal therapy and reduced corticosteroid use led to successful clinical outcomes.

Conclusions:

Infectious panniculitis due to Histoplasma capsulatum can occur in dermatomyositis patients.
Panniculitis may be misdiagnosed as a dermatomyositis flare, necessitating a high index of suspicion for histoplasmosis.
Prompt antifungal treatment and immunosuppression adjustment are effective.