E-mail Id: drpratapsingh@ Histoplasmosis is a fungal infection and prevalent worldwide, in which Ohio and
yahoo.co.in Mississippi river valleys of North America have the highest prevalence. There are a
few case reports of this fungal infection from non-endemic regions too.1-3 In India,
histoplasmosis has been reported in large numbers from eastern states like West
Bengal,4,5 and a few cases from southern states as well.6,7 Other regions of the
country rarely see any cases of histoplasmosis. Histoplasmosis is most commonly
seen in immunosuppressed patients8 but there are a few case reports in
immunocompetent hosts as well.9,10
Case Presentation
An 18-year-old, unmarried male patient, resident of Delhi (central India), presented
to our hospital with complaints of low-grade prolonged fever, loss of appetite and
weight loss of 10 kg in last 4 months. No history of high-risk behavior, promiscuous
sexual activities or blood transfusion in the past. He was a non-smoker and non-
alcoholic. There was also no history of exposure to bird’s dropping or recent travel to
How to cite this article:
endemic parts of the country. There was no past history of tuberculosis, diabetes
Singh P, Kumar S, mellitus or any other chronic systemic illness.
Dharmshaktu P et al.
Progressive Disseminated On examination, the patient was of thin-built male with stable vitals. There were
Histoplasmosis in an multiple umbilicated papular to nodular lesions over forehead and chin, without any
Immunocompetent Host erythema or tenderness (Fig. 1).
with Reversible CD4
Lymphocytopenia. J Adv Res He had pallor, but no icterus, clubbing, cyanosis, or peripheral lymphadenopathy.
Med 2016; 3(2&3): 14-17. The abdominal examination revealed mild, non-tender hepatosplenomegaly, but no
ISSN: 2349-7181
free fluid. The chest and cardiovascular examination did not reveal any abnormality.
Figure 2.Multiple Ill-Defined Non-caseating Granulomas Present with Yeast Forms of Histoplasma Capsulatum
(Arrow) in the Skin Biopsy
15 ISSN: 2349-7181
Singh P et al. J. Adv. Res. Med. 2016; 3(2&3)
Figure 4.Yeast Forms within Macrophages on Silver Methanamine and PAS Stain on Bone Marrow Biopsy (Arrow)
ISSN: 2349-7181 16
J. Adv. Res. Med. 2016; 3(2&3) Singh P et al.
presented with skin lesion, the biopsy of which 7. Nair SP, Vijayadharan M, Vincent M. Primary
confirmed histoplasma. Similar skin-colored, papulo- cutaneous histoplasmosis. Indian J Dermatol
nodular lesions have been seen in literature. However Venereol Leprol 2000; 66: 151-53.
the lesions were present on head, trunk and extremity. 8. Sayal SK, Prasad PS, Sanghi S. Disseminated
It was also associated with nodulo-ulcerative growth in histoplasmosis: Cutaneous presentation. Indian J
hard palate.11 Patient living with HIV and AIDS may Dermatol Venereol Leprol 2003; 69: 90-91.
present with reddish papules and pustules in the skin of 9. Sharma S, Kumari N, Ghosh P et al. Disseminated
the scalp, face, back, thighs, abdomen, palms, and histoplasmosis in an immune competent individual-
soles.12 Our patient also had bicytopenia and A case report. Indian J Pathol Microbiol 2005; 48:
hepatosplenomegaly, which is a feature of infection of 204-206.
reticuloendothelial system and bone marrow 10. Alcure ML, Di HipólitoJúnior O, Almeida OP et al.
involvement.13 Our patient was negative for HIV and had Oral histoplasmosis in an HIV-negative patient. Oral
low CD4 lymphocyte count at presentation. There have Surg Oral Med Oral Pathol Oral Radiol Endod 2006;
been a few case reports, from various parts of the 101: 33-36.
world, of immunocompetent patients presenting with 11. Harnalikar M, Kharkar V, Khopkar U. Disseminated
infections which are normally seen in HIV-AIDS patients cutaneous Histoplasmosis in an immunocompetent
or in patients with immunosuppression.14-20 These adult. Indian J Dermatol May-Jun 2012; 57(3): 206-
infections are, however, associated with idiopathic low 209.
CD4 lymphocytopenia or dysfunction of T helper cells. In 12. Kucharski LD, Dal Pizzol AS, Neto FJ et al.
our patient, we suspected this condition but the repeat Disseminated cutaneous histoplasmosis and AIDS:
count after 3 weeks came out to be normal; hence, this Case report. Braz J Infect Dis Oct 2000; 4(5): 255-61.
condition was ruled out. 13. Mukherjee A, Tangri R, Verma N et al. Chronic
disseminated histoplasmosis bone marrow
Learning Points involvement in an immunocompetent patient.
Indian J Hematol Blood Transfus Apr-June 2010;
Progressive disseminated histoplasmosis should be 26(2): 65-67.
considered in a immunocompetent host. It may be seen 14. Pankhurst C, Peakman M. Reduced CD4+ T-cells and
in HIV-AIDS negative individuals with low CD4 count. severe oral candidiasis in absence of HIV infection.
Low CD4 count is reversible on treatment of Lancet 1989; 1: 672.
histoplasmosis with anti-fungal therapy. 15. Jowitt SN, Love EM, Liu Yin JA et al. CD4
lymphocytopenia without HIV infection in patient
Conflict of Interest: None with cryptococcal infection. Lancet 1991; 337: 500-
501.
References
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Date of Acceptance: 27th Sep. 2016
17 ISSN: 2349-7181