Disseminated Histoplasmosis: The Great Mimicker in Patients With Advanced HIV Disease

Histoplasmosis is a systemic mycosis. In patients infected with HIV, the disseminated form represents one of the most severe presentations of the disease. While the infection primarily manifests in the pulmonary system, it can also present cutaneously or intestinally, posing a significant diagnostic challenge. We report the case of a 28-year-old male patient with a diagnosis of HIV and disseminated histoplasmosis (involving cutaneous, pulmonary, and intestinal systems). He presented with disseminated dermatosis, hepatosplenomegaly, pancytopenia, dysphagia, and subsequent gastrointestinal bleeding; skin and intestinal biopsies confirmed the diagnosis. The patient was treated with amphotericin B (sodium deoxycholate), resulting in a favorable clinical outcome. He was discharged with a subsequent regimen of oral antifungal therapy and antiretrovirals. Disseminated histoplasmosis remains a frequent opportunistic infection in patients living with HIV. Cutaneous manifestations are often nonspecific. In patients with severe immunosuppression, histoplasmosis should always be considered among the differential diagnoses.