Cutaneous Histoplasmosis in a Renal Transplant Patient Presenting With Hand and Forearm Necrotizing Myofasciitis

Area of Science:

• Mycology
• Infectious Diseases
• Transplantation Immunology

Background:

• Histoplasmosis is a fungal infection typically affecting the lungs.
• Primary cutaneous histoplasmosis of the extremities is uncommon.
• Renal transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.

Observation:

• A renal transplant patient developed a primary cutaneous histoplasmosis infection of the upper extremity.
• The infection presented as an aggressive myofasciitis.
• Initial treatment allowed for limb salvage, but infection recurred.

Findings:

• Recurrent aggressive myofasciitis due to Histoplasma capsulatum necessitated a below-elbow amputation.
• Direct inoculation of the fungus into the extremity occurred.
• The case underscores the potential severity of disseminated histoplasmosis in immunocompromised individuals.

Implications:

• Early recognition and aggressive management are crucial for managing cutaneous histoplasmosis in transplant patients.
• Amputation may be required in severe, refractory cases of extremity histoplasmosis.
• This case emphasizes the importance of considering unusual presentations of fungal infections in immunocompromised hosts.