Unusual presentation of disseminated histoplasmosis in an immunocompetent patient

Disseminated histoplasmosis (DH) is a systemic granulomatous disease caused by the fungus Histoplasma capsulatum. This disease occurs mainly in immunocompromised individuals with CD 4 counts less than 200 cell/µL and is rarely noted in immunocompetent person. In India, this disease has been reported from several parts of the country of which most cases are from eastern India which is considered to be endemic for this disease. Inhalation of the spores can lead to a self-limiting flulike illness in immunocompetent hosts. The most common organs involved are liver, spleen, bone marrow, lymphoreticular system, and gastrointestinal tract. Cutaneous manifestations of histoplasmosis are rare and are seen predominantly in persons with advanced human immunodeficiency virus (HIV) infections. We present a case of DH with generalized cutaneous lesions in a non-HIV infected adult which posed a diagnostic challenge to our clinical colleagues.