Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference29 articles.
1. Arango-Bustamante K, Restrepo A, Cano LE, De Bedout C, Tobón AM, González A. Diagnostic value of culture and serological tests in the diagnosis of histoplasmosis in HIV and non-HIV Colombian patients. Am J Trop Med Hyg. 2013;89(5):937–42.
2. Joseph Wheat L, Connolly-Stringfield PA, Baker RL, Curfman MF, Eads ME, Israel KS, et al. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine (United States). 1990;69:361–74.
3. de Oliveira RD, de Alencar RRFR, Antonio BVR, Leal PC, dos Santos Franco E, dos Santos LM. Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis. Dermatol Online J. 2019;25(8).
4. Sánchez-Saldaña L, Galarza C, Cortéz FF. Infecciones micóticas sistémicas o profundas: histoplasmosis. Dermatol Peru. 2010;20(1):139–52.
5. da Silva Ferreira B, de Araújo Filho JA, Pereira NM, de Miranda Godoy L, Lamounier BB, Nunes ED, et al. Disseminated histoplasmosis in aids patients: an urban disease. Experience in a metropolis in the middle east of Brazil. Infez Med. 2017;25(3):258–62.