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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.
Abstract:
This report describes the coexistence of infectious panniculitis due to Histoplasma capsulatum in three patients with dermatomyositis. In each case, the appearance of panniculitis was the predominant clinical manifestation of histoplasmosis. Oral ulcers, lymphadenopathy, pulmonary infiltrates, hepatosplenomegaly, and other cardinal features of disseminated histoplasmosis were notably absent. The clinical presentation of panniculitis may initially be interpreted as worsening of dermatomyositis and can lead to delay in diagnosis and institution of antifungal therapy.Histoplasmosis should be placed high on the differential diagnosis whenever symptomatic panniculitis is observed in the setting of myositis. Clinicians should not be reluctant to perform full thickness biopsies in patients with panniculitis who are on immunosuppressive therapies. Antifungal therapy and reduction in corticosteroids resulted in excellent clinical response with no relapse of infection in this small series.
Insights
Histoplasmosis can cause infectious panniculitis in dermatomyositis patients, mimicking disease flares. Early diagnosis and treatment with antifungals are crucial for recovery.
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.
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