Disseminated histoplasmosis in a patient with HIV diagnosed by simple bedside investigations

Description

A 41-year-old HIV-infected woman presented with prolonged fever at another hospital. Besides low CD4 count (8 cell/mm³) and pancytopaenia, blood cultures, chest radiograph, chest–whole abdominal CT and bone marrow examination were unremarkable. Empirical treatment for tuberculosis was given. One week later, she developed rash and was transferred to our hospital. Physical examination showed multiple pruritic erythematous purplish maculopapular rashes with central necrotic areas predominantly on face, back-chest wall and both forearms (figure 1). Peripheral blood smear (figure 2) and skin scraping (figure 3) revealed multiple intracellular yeast-like organisms suggestive of Histoplasma capsulatum. Intravenous amphotericin B was given, followed by oral itraconazole. Her condition improved after 2 weeks of treatment. Antiretroviral medications were initiated 1 month later.

Figure 1

Multiple pruritic erythematous purplish maculopapular rashes with some central necrotic areas predominantly on the (A) face, (B) back-chest wall and (C,D) both forearms.

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