Severe anal ulceration secondary to Histoplasma capsulatum in a patient with HIV disease.

Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. Histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the Mississippi and Ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.