Cutaneous histoplasmosis with prominent parasitization of epidermal keratinocytes: report of a case

Abstract

Disseminated histoplasmosis most commonly occurs in immunosuppressed individuals and involves the skin in approximately 6% of patients. Cutaneous histoplasmosis with an intraepithelial-predominant distribution has not been described. A 47-year-old man was admitted to our institution with fever and vancomycin-resistant enterococcal bacteremia. He had been diagnosed with T-cell prolymphocytic leukemia 4 years earlier and had undergone matched-unrelated-donor stem cell transplant 2 years earlier; on admission, he had relapsed disease. His medical history was significant for disseminated histoplasmosis 6 months before admission, controlled with multiple antifungal regimens. During this final hospitalization, the patient developed multiple 2-5 mm erythematous papules, a hemorrhagic crust across the chest, shoulders, forearms, dorsal aspect of the fingers, abdomen and thighs. Skin biopsy revealed clusters of oval yeast forms mostly confined to the cytoplasm of keratinocytes and within the stratum corneum; scattered organisms were present in the underlying superficial dermis without any significant associated inflammatory infiltrate. Special stains and immunohistochemical studies confirmed these to be Histoplasma organisms. We highlight this previously unrecognized pattern of cutaneous histoplasmosis to ensure its prompt recognition and appropriate antifungal therapy.

Pulmonary Histoplasma Infection After Allogeneic Hematopoietic Stem Cell Transplantation: Case Report and Review of the Literature

“…We found 5 cases of histoplasmosis complicating an allogeneic HSCT in the English literature [1][2][3][4][5]. The pertinent case details are summarized in Table 1 along with our patient.…”

“…Histoplasmosis can range in spectrum from a localized pulmonary to a disseminated infection and can affect both immunocompetent and immunocompromised hosts. However, only a few cases of histoplasmosis have been reported in the allogeneic hematopoietic stem cell transplant (HSCT) population [1][2][3][4][5]. In this study, we report an allogeneic HSCT recipient from an endemic country in Central America who developed pulmonary histoplasmosis, review the literature of histoplasmosis in this patient population, and highlight the use of positron-emission tomography (PET) imaging and pan-fungal polymerase chain reaction (PCR), which were helpful in making the diagnosis.…”

Histoplasma capsulatum Infection in an Allogeneic Hematopoietic Stem Cell Transplant Patient Receiving Voriconazole Prophylaxis

“…In a prospectively collected series of solid organ and HSCT patients diagnosed with endemic mycoses, only three of 16,200 HSCT recipients of histoplasmosis were identified (0.02%) of which only one patient underwent an allogeneic transplant [16]. Overall, there have been an estimated seven cases of histoplasmosis reported in the allogenic HSCT population, of which four patients with reported outcomes died [2,4,5,7,17,18]. Furthermore, there have been no previously reported cases of histoplasmosis in patients where antifungal prophylaxis with agents that have clinical activity against Histoplasma were used as was in our reported case.…”

An immigrant with acquired immunodeficiency syndrome presenting with a rash: A case report

“…7 Histoplasmosis is commonly transmitted through the inhalation of fungal microconidia from soil contaminated with infected bird or bat guano. 8 Cutaneous disease can result from hematogenous dissemination, and rarely from implantation directly into the skin. 1 Both classical and African histoplasmosis can reactivate from latent granulomata decades after the primary infection.…”