Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Oliveira, Ronísie Duarte de; Alencar, Raquel Rodrigues Ferreira Rocha de; Antonio, Bruno Vianei Real; Leal, Patrícia Cal; Franco, Emily dos Santos; Santos, Luciana Mendes dos

doi:10.5070/d3258045127

Cited by 1 publication

(3 citation statements)

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“…The diagnosis is made by histology and periodic acid Schiff (PAS) stain, which is considered the gold standard. Although the culture is highly specific, it has several limitations including a variable sensitivity in HIV patients between 75% and 85-95% [1,3,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Lower ratio of T:CD4 lymphocyte has been associated with cutaneous-systemic manifestations. In HIV patients, histoplasmosis induce atypical dysfunction of the tissue macrophages in the dermis with infiltration of inflammatory cells and cytokines with consequent tissue necrosis [3]. We report a young-male-patient with AIDS and systemic histoplasmosis with a complete destruction of the dorsal and lateral cartilage of the nose and a consequent flattening of the nose tip to the maxillary bone.…”

Section: Introductionmentioning

confidence: 93%

“…2 Eugenio Espejo Hospital, Quito, Ecuador. 3 Derma Aid, Quito, Ecuador. 4 Department of Pathology, Hospital Axxis, Quito, Ecuador.…”

Section: Abbreviationsmentioning

confidence: 99%

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Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS

Escalante

Granizo-Rubio

Pinos-León³

et al. 2022

BMC Infect Dis

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Background Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. Case presentation We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. Conclusions Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.

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