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Disseminated Histoplasmosis Diagnosed by "Touch Prep".

Jacob Kingsley¹, Dillon Clarey², Scott R Lauer³

¹College of Medicine, University of Nebraska Medical Center, Omaha, NE; and.

The American Journal of Dermatopathology

|July 24, 2020

Summary

Disseminated histoplasmosis, a serious fungal infection, can be rapidly diagnosed using touch wet preparation of skin biopsies. This quick bedside method aids in identifying Histoplasma capsulatum within giant cells, enabling timely treatment.

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Area of Science:

Medical Mycology
Infectious Diseases
Dermatopathology

Background:

Disseminated histoplasmosis is a severe systemic infection caused by the fungus Histoplasma capsulatum.
Cutaneous involvement is a recognized manifestation, necessitating accurate and prompt diagnosis for effective management.

Observation:

A case of disseminated histoplasmosis with skin lesions is presented.
Diagnosis was achieved using a touch wet preparation (touch prep) from a punch biopsy of a skin lesion.

Findings:

The touch prep, utilizing Wright-Giemsa stain and KOH with chlorazol black, revealed numerous yeast forms of Histoplasma capsulatum within multinucleated giant cells.
Histopathology and culture confirmed the diagnosis.
This highlights the utility of wet prep techniques for rapid, on-site identification of the causative agent in cutaneous lesions.

Implications:

Touch wet preparations offer a valuable, rapid bedside diagnostic tool for cutaneous histoplasmosis.
Early diagnosis facilitates prompt initiation of antifungal therapy, potentially improving patient outcomes.
Understanding the histopathologic features aids in differentiating Histoplasma from other causes of parasitized histiocytes.