Savings or convenience? Why not both! Buy Bactrim with us!

Disseminated histoplasmosis is a serious disease that affects the skin, lungs, and internal organs. It is one of the diseases that characterize acquired immunodeficiency syndrome (AIDS), and in endemic areas is one of the more commonly observed infections in AIDS patients. The mortality rate in patients with AIDS and histoplasmosis is high if untreated. Disseminated histoplasmosis may have a variety of dermatological manifestations. In this article, we provide the first report of diffuse ulcerations due to disseminated histoplasmosis. These ulcers developed while the patient was on stavudine, lamivudine, and indinavir, and had a CD-4 count of 525 [mm.sup.3]. The patient’s histoplasmosis resolved with itraconazole monotherapy.

Related Results

West Nile Virus infection in a renal transplant recipient

Drug challenge

Viewpoint

Transient Neutrophilic Thrombophagocytosis Associated With Citrobacter freund…

Long Island Technology Briefs: September 30, 2005

Histoplasmosis is a well-described opportunistic infection that accompanies human-immunodeficiency virus (HIV) infection. We report an unlikely victim of disseminated histoplasmosis who suffered this infection while on antiretroviral therapy and with a CD-4 count of 525/[mm.sup.3]. Notably, he had a normal chest x-ray and disseminated cutaneous ulcers. The diagnosis was made by skin biopsy, and his infection responded promptly to itraconazole therapy. This case serves as a reminder that the immunological derangements and cutaneous alterations wrought by HIV remain unpredictable in nature and extent.
**********
Case Report
A 36 year old Puerto Rican man, seropositive for HIV with a recent absolute CD-4 count of 525/[cc.sup.3] and a viral load of 191,000 [mm.sup.3], was admitted with joint pain and progressive rash, fever, and dysphagia. His medications on admission were stavudine, lamivudine, indinavir, and bactrim, which he had started two months prior to admission.
The patient stated that his rash had started four months prior to admission. At that time, he had sought medical attention and had been diagnosed with HIV. He denied prior history of skin problems. A month before admission, the patient developed focal joint pain and lower extremity edema that made walking painful. For the 7 years prior to admission, the patient had worked in Puerto Rico as a security guard at an oil refinery adjacent to a highway construction site. His past medical history was notable for bronchitis, pneumonia, anemia, sinusitis, and joint pain. His social history was notable for a forty-year history of cigarette use, and for smoking cocaine. The patient denied alcohol use, intravenous drug use, or homosexual activity.
Physical examination revealed 3 white annular patches on the palate and numerous ulcerated nodules in a generalized distribution. The bases of these ulcers were dry and crusted without purulence. Bilateral non-pitting leg edema was present. The patient was febrile to 102[degrees]E An initial diagnosis of cutaneous T-cell lymphoma was considered.
The patient’s chest x-ray was unremarkable. His laboratory values were notable for a white blood cell count of 10,600 [mm.sup.3], a hemoglobin level of 9.5 g/dl, and a hematocrit of 28.7%. Levels of blood urea nitrogen, creatinine, serum electrolytes, liver function tests, platelets, and glucose were normal. Histopathologic examination of a skin biopsy specimen from the border of a nodule on the left arm showed necrotizing granulomatous inflammation in the dermis and numerous small yeast forms, consistent with histoplasmosis. The patient was treated with 400 milligrams of itraconazole twice daily, and the ulcers resolved over the course of several weeks.
Discussion
In areas and among patient populations where histoplasmosis is endemic, unusual dermatological findings suggest consideration of histoplasmosis as the pathologic entity. Untreated disseminated histoplasmosis has a high mortality rate (1) and can quickly kill patients with AIDS (2). Disseminated histoplasmosis has cutaneous findings in 6% of immunocompetent and 11% of immuno-compromised patients, respectively (3). Evaluation of patients with unusual skin findings requires prompt biopsy because histologic examination of tissue provides the most rapid means of diagnosis of this condition (4). Fungal culture, which takes 2-3 weeks to reveal growth, can be used to confirm the diagnosis. A radioimmunoassay (RIA) to detect histoplasmosis in urine is also available (5).
Disseminated histoplasmosis can have a variety of dermatological manifestations that include papules, macules, patches, mucosal ulcers, cutaneous ulcers, plaques, pustules, fistulae, and folliculitis (6). Previous reports of cutaneous ulcers due to disseminated histoplasmosis have been limited in extent. One report was noted with a presentation similar to the instant one with disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions (7). One patient had papules that developed into ulcers on the neck, intergluteal region, forehead, back, and neck, but did not appear on the legs, trunk, or hands (8). Other reports have noted ulcers on the lips (9), in the perianal region (10), on the back (11), and on the penis (12); mucosal ulcers have been commonly reported as well (13). This case marks the first report of disseminated cutaneous ulcers.