Experience of Varied Presentation of Chronic Progressive Disseminated Histoplasmosis in Immunocompetent Patients: A Diagnostic Conundrum.
We report two cases of chronic progressive disseminated histoplasmosis with unusual and rare clinical picture in a patient with no underlying risk factor. One 50-year-old male, presented with hoarseness of voice, chronic cough, with a history of nonresponding anti-tubercular therapy, revealed mucocutaneous lesions on examination. Fungating vocal cord lesions were visualized on bronchoscopy, raised suspicion of carcinoma. The second case, a 22-year-old female, referred to hospital with suspected vasculitis, with complaints of "off and on" fever with decreased oral intake, arthralgia, who later developed generalized nodular skin eruptions. On investigation, human immunodeficiency virus test was found to be negative in both the cases. Histopathological findings of skin biopsy, adrenal and bone marrow aspirates raised suspicion, whereas fungal cultures confirmed Histoplasma infection. Although diagnosis was delayed, but both of them were successfully treated with amphotericin B.
Department of Microbiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Roumi
R
Ghosh
Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Pranshu
P
Mishra
Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Sumit
S
Sen
Department of Microbiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Prasanta Kumar
PK
Maiti
Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Govinda
G
Chatterjee
Antifungal; Histoplasma capsulatum; hemophagocytosis; immunocompetent; laryngeal lesion
Trans R Soc Trop Med Hyg. 1999 Sep-Oct;93(5):540-2
10696417
J Indian Med Assoc. 1954 Mar;23(6):257-8
13152378
Clin Microbiol Rev. 2007 Jan;20(1):115-32
17223625
Clin Infect Dis. 2007 Oct 1;45(7):807-25
17806045
Med Mycol. 2013 Oct;51(7):774-8
23547881
J Assoc Physicians India. 2012 Oct;60:25-8
23777021
Med Mycol Case Rep. 2013 Apr 21;2:103-7
24432229
Natl Med J India. 2013 Jul-Aug;26(4):214-5
24758444
Open Forum Infect Dis. 2015 Apr 15;2(2):ofv055
26380347
J Assoc Physicians India. 2015 Jun;63(6):69-71
26710405
J Clin Diagn Res. 2016 Mar;10(3):OD03-5
27134914
Indian J Dermatol Venereol Leprol. 1980 Mar-Apr;46(2):94-98
28218139