An unusual presentation of cutaneous histoplasmosis as a recurrent solitary and spontaneously healing lesion in an immunocompetent patient. Issue 9 (21st September 2020)

• Record Type: Journal Article
• Authors: Muldoon, Jessica L.; Wysozan, Timothy R.; Toubin, Yulianna; Relich, Ryan F.; Davis, Thomas E.; Zhang, Chen; Alomari, Ahmed K.
• Is Part Of: Access microbiology. Volume 2:Issue 9(2020)
• Publication Date: 2020-09-21
• Subjects: dermatopathology -- fungal infections -- Histoplasma; Microbiology -- Periodicals; 579
• DOI: 10.1099/acmi.0.000156
• Languages: English
• ISSNs: 2516-8290

Abstract

Abstract : Infection with Histoplasma capsulatum typically manifests as a self-limiting pulmonary disease in immunocompetent patients. Systemic symptoms such as cutaneous lesions are associated with immunodeficient states. Our patient was an immunocompetent 68-year-old male who presented with a plaque on his left infraorbital area that was concerning for malignancy. Histological examination of the lesion revealed granulomatous inflammation and small yeast forms suggestive of H. capsulatum . The lesion resolved spontaneously and recurred 1 year later. On recurrence, histological examination again revealed yeast forms consistent with H. capsulatum . Serum and urine testing for H. capsulatum antigen were negative. Next-generation sequencing detected H. capsulatum, which supported the diagnosis of a cutaneous infection. The patient was prescribed and started treatment with itraconazole for 1 year after recurrence of the lesion, and he has not reported further disease recurrence to date. This case is unique because of the presentation of a primary cutaneous recurrent H. capsulatum lesion, and it demonstrated the utility of laboratory testing in its diagnosis.