title: Cytodiagnosis of cutaneous histoplasmosis in HIV positive patient initially presenting with multiple umbilicated disseminated skin nodules.
abstract: Histoplasmosis is usually an opportunistic fungal infection in patients with defective cell mediated immunity, and has been considered as one of the acquired immunodeficiency syndrome (AIDS) defining illness. However, cutaneous involvement in human immunodeficiency virus (HIV) positive patients is less common, and very rarely can be the initial presenting symptom for the diagnosis of AIDS. We present here an unusual case of multiple diffuse cutaneous nodular lesions predominantly in face, trunk, and upper extremities diagnosed initially on aspiration cytology as histoplasmosis. Subsequent serological test revealed positivity for HIV 1 and 2, along with a low CD4 count and low CD4:CD3 ratio. The cytomorphological features were further corroborated by histology and histochemical stains. Hence, cutaneous histoplasmosis can cause multiple wide spread nodular or umbilicated lesions in AIDS patients as the initial presentation. Fine needle aspiration cytology (FNAC) is a rapid, cost effective tool for diagnosis of the fungi from such lesions and initiating work up for immunocompromised states including AIDS.
authors: Department of Pathology, The West Bengal University of Health Sciences, Kolkata, West Bengal, India. drarghyabanerjee@yahoo.com.
authors: Bandyopadhyay
authors: B
authors: Arghya
authors: Majumdar
authors: M
authors: Kaushik
authors: Gangopadhyay
authors: G
authors: Mimi
authors: Chakraborty
authors: C
authors: Subrata
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology; D003881:Dermatomycoses / Q000175:diagnosis* / Q000382:microbiology; D015658:HIV Infections / Q000175:diagnosis* / Q000382:microbiology; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008976:Molluscum Contagiosum / Q000175:diagnosis* / Q000382:microbiology