title: 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.
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
authors: Hedieh H
authors: HH
authors: Honarpisheh
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jonathan L
authors: JL
authors: Curry
authors: Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Kristen
authors: K
authors: Richards
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Priyadharsini
authors: P
authors: Nagarajan
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Phyu P
authors: PP
authors: Aung
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Carlos A
authors: CA
authors: Torres-Cabala
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Doina
authors: D
authors: Ivan
authors: Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Carol R
authors: CR
authors: Drucker
authors: Department of Pathology, Hartford Hospital, Hartford, CT, USA.
authors: Richard
authors: R
authors: Cartun
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Victor G
authors: VG
authors: Prieto
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Michael T
authors: MT
authors: Tetzlaff
mesh_terms: D003881:Dermatomycoses / Q000276:immunology / Q000469:parasitology / Q000473:pathology*; D004817:Epidermis / Q000469:parasitology; D006660:Histoplasmosis / Q000276:immunology / Q000469:parasitology / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D015603:Keratinocytes / Q000469:parasitology*; D015458:Leukemia, T-Cell / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation
keywords: histoplasmosis; immunosuppression; infection; stem cell transplant