Histoplasmosis clinically imitating cutaneous malignancy.
Disseminated histoplasmosis can have a varied presentation when it affects the skin. Presentation mimicking a cutaneous neoplasm is an uncommon manifestation. We present the case of an 86-year-old man presenting with a cutaneous lesion clinically suspicious for malignancy that was ultimately determined to be his first clinical manifestation of disseminated histoplasmosis after biopsy for histopathologic analysis. Microscopically, the lesion was a nodule with an eroded epidermis overlying a dense dermal inflammatory process. The infiltrate was characterized by numerous epithelioid histiocytes admixed with acute and chronic inflammation. On closer inspection, numerous 2-4 mum intracellular spores surrounded by a clear halo were identified. The organisms were highlighted with periodic acid schiff (PAS) stain. We present this case to highlight a unique presentation of disseminated histoplasmosis. Although this presentation is uncommon, it serves as a reminder that histopathologic confirmation of clinical diagnoses is important before undertaking more invasive procedures such as excision.
Golda
Nicholas
N
Department of Dermatology, University of Missouri Columbia, Columbia, MO 65212, USA. goldan@health.missouri.edu
Feldman
Mary
M
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D012628:Dermatitis, Seborrheic / Q000150:complications; D003937:Diagnosis, Differential; D006660:Histoplasmosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017964:Itraconazole / Q000627:therapeutic use; D055623:Keratosis, Actinic / Q000150:complications; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000473:pathology*
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D017964:Itraconazole; D011241:Prednisone; D008727:Methotrexate