Diagnosis: Disseminated histoplasmosis with cutaneous and gastrointestinal involvement.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
The skin biopsy specimen revealed sheets of epithelioid-type histiocytes throughout the dermis, which was densely parasitized by organisms, with a focal necrotizing tuberculoid-type granuloma within the superficial dermis that was composed of an admixture of epithelioid-type histiocytes and lymphocytes. The patient underwent an exploratory laparotomy with partial ileocecotomy and resection of a mesenteric mass. Culture of the resected tissue revealed Histoplasma capsulatum var capsulatum. One week of treatment with amphotericin B followed by itraconazole therapy (200 mg twice a day) resulted in resolution of the patient's systemic symptoms and eruption.
DISCUSSION
Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum var capsulatum and is endemic to the Western Hemisphere, particularly the Mississippi and Ohio River valleys.1 The infection is acquired by the inhalation of conidia from soil contaminated by bird and bat excreta.2 Three forms of histoplasmosis exist: acute pulmonary, chronic cavitary, and disseminated.2 Disseminated histoplasmosis is a common manifestation . . . [Full Text of this Article]
