Disseminated histoplasmosis in an HIV-positive Filipino

ABSTRACT

Introduction@#Histoplasmosis is a granulomatous infection caused by the fungus, Histoplasma capsulatum. The disseminated type can be the initial manifestation of HIV/AIDS. It may affect the lungs, skin, gastrointestinal tract, liver, spleen, genitourinary tract, heart, bone marrow, adrenal glands, lymph nodes, and the central nervous system. Cutaneous findings are diverse and most present with few nodules and ulcerative lesions with involvement of the mucosal surface.@*Case summary@#This article describes the case of a 42-year-old male who presented fever, cough, oral ulcers, and multiple brownish nodular papules and plaques on the lips, face, trunk and extremities. Skin biopsy with tissue culture and sensitivity revealed Histoplasma capsulatum which was resistant to the recommended treatment, Amphotericin-B and Itraconazole. The patient was seropositive for HIV.@*Conclusion@#The incidence of HIV in the Philippines is rapidly increasing and we are expected to encounter more cases of opportunistic infections, such as in this case. Having a high index of clinical suspicion is important in establishing a diagnosis. In patients with HIV/AIDS or presumed to have AIDS presenting with multiple cutaneous lesions, skin biopsy for identification, culture, and sensitivity studies are valuable in determining the diagnosis and initiating treatment. Furthermore, the stigma of being diagnosed with HIV/AIDS prevents people from having HIV tests done. This causes delay in the diagnosis and treatment, and results in higher mortality. Public education and patient counseling are therefore vital in addressing the HIV epidemic.