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Unmasking histoplasmosis immune reconstitution inflammatory syndrome in a patient recently started on antiretroviral therapy

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ABSTRACT

Histoplasmosis is the most common endemic mycoses among HIV-infected people. Patients with suppressed cell immunity mainly due to HIV are at increased risk of disseminated disease. Dermatological manifestations of immune reconstitution inflammatory syndrome (IRIS) and cutaneous manifestations of histoplasmosis similar to an IRIS event have been previously described. We report the case of a 43-year-old male who presented with cutaneous disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum 4 months after the onset of the antiretroviral therapy and some improvement in the immune reconstitution. After 2 weeks of amphotericin B and itraconazole therapy, the scheduled treatment involved fluconazole maintenance therapy, which resulted in an improvement of his skin lesions.

No MeSH data available.


Photomicrography of the skin biopsy. A - Normal epidermis and infiltrated dermis (H&E, 100X); B, C, and D - Small, oval, narrow based yeasts consistent with Histopolasma capsulatum (H&E, 400X).
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g02: Photomicrography of the skin biopsy. A - Normal epidermis and infiltrated dermis (H&E, 100X); B, C, and D - Small, oval, narrow based yeasts consistent with Histopolasma capsulatum (H&E, 400X).

Mentions: The serological test for HIV was positive. The viral load for HIV was undetectable, and CD4 was 108 cells/mm3. Diagnoses of Kaposi sarcoma, bacillary angiomatosis, squamous cell carcinoma, and invasive mycosis were considered. A punch biopsy was obtained from two lesions of the face. Histological examination showed granulomatous dermatitis with round cytoplasmic organelles within the macrophages consistent with H. capsulatum var. capsulatum (Figure 2 and Figure 3).


Unmasking histoplasmosis immune reconstitution inflammatory syndrome in a patient recently started on antiretroviral therapy
Photomicrography of the skin biopsy. A - Normal epidermis and infiltrated dermis (H&E, 100X); B, C, and D - Small, oval, narrow based yeasts consistent with Histopolasma capsulatum (H&E, 400X).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304559&req=5

g02: Photomicrography of the skin biopsy. A - Normal epidermis and infiltrated dermis (H&E, 100X); B, C, and D - Small, oval, narrow based yeasts consistent with Histopolasma capsulatum (H&E, 400X).
Mentions: The serological test for HIV was positive. The viral load for HIV was undetectable, and CD4 was 108 cells/mm3. Diagnoses of Kaposi sarcoma, bacillary angiomatosis, squamous cell carcinoma, and invasive mycosis were considered. A punch biopsy was obtained from two lesions of the face. Histological examination showed granulomatous dermatitis with round cytoplasmic organelles within the macrophages consistent with H. capsulatum var. capsulatum (Figure 2 and Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Histoplasmosis is the most common endemic mycoses among HIV-infected people. Patients with suppressed cell immunity mainly due to HIV are at increased risk of disseminated disease. Dermatological manifestations of immune reconstitution inflammatory syndrome (IRIS) and cutaneous manifestations of histoplasmosis similar to an IRIS event have been previously described. We report the case of a 43-year-old male who presented with cutaneous disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum 4 months after the onset of the antiretroviral therapy and some improvement in the immune reconstitution. After 2 weeks of amphotericin B and itraconazole therapy, the scheduled treatment involved fluconazole maintenance therapy, which resulted in an improvement of his skin lesions.

No MeSH data available.