P21 Facial papules in an immunocompromised patient

Abstract A 29-year-old man presented with a 6-week history of clustered facial papules. Of note, he had diagnosis HIV 5 months previously and was on maintenance antiretroviral treatment. His initial CD4 count 5, which increased to 38, his viral load now no longer detectable. He also been treated for cytomegalovirus reactivation, pneumocystis pneumonia suspected mycobacterium infection the previous 3 months. ongoing symptoms malaise, fevers, weight loss nausea, along abnormal liver function tests raised C-reactive protein. bone marrow trephine showed noncaseating discrete small granulomas; Grocott periodic acid–Schiff (PAS) stains were negative. Prior dermatology review, papules initially perioral empiric valaciclovir herpes simplex virus (HSV) but resolution. Testing HSV DNA syphilis On examination, there clusters nontender, well-circumscribed (some umbilicated), distributed forehead, cheeks, cutaneous mucosal lips. diagnostic punch biopsy taken one characteristic Histological examination demonstrated dense dermal infiltrate histiocytes focal non-necrotizing granuloma formation. Interspersed neutrophilic microabscesses occasional eosinophils present. PAS stain fungi confirmed presence numerous thick-walled spherules, many single distinct nucleus, some showing binucleation, consistent fungal organisms located within in dermis. Differential included histoplasmosis, cryptococcosis, blastomycosis coccidiomycosis. commenced intravenous liposomal amphotericin B disseminated endemic mycosis while awaiting definitive diagnosis. Formal identification by panfungal polymerase chain reaction skin tissue positive Histoplasma capsulatum itraconazole added. The histoplasmosis involvement. lesions resolved completely over 4 weeks, residual hyperpigmentation remaining. is dimorphic fungus found soil droppings bats birds. Infection through spore inhalation, most patients being asymptomatic. It more prevalent temperate tropical climates. Disseminated occurs mostly immunocompromised individuals can be fatal if left untreated. Although specific world regions, should considered presenting atypical findings, even regions low prevalence.