Cutaneous histoplasmosis associated with acquired immunodeficiency syndrome (AIDS)

A 30‐year‐old man, who had originally been admitted to the Centro Dermatológico Pascua for medical attention and was later transferred to the Hospital General de México, presented with a 2‐month history of progressive dermatosis affecting the head (face, ear lobes, oral cavity), trunk (all faces), upper and lower limbs (including the palms and soles), external genitalia, and the perianal region. The patient had no history of homosexuality, but did have a long history of sexual intercourse with prostitutes in the city of Ciudad del Carmen (island in southeastern Mexico), where he was born and lives. The dermatosis consisted of multiple nodules and ulcerative lesions, some of them isolated and others with junctions between them, forming verrucous plaques. He complained of mild pruritus and pain. The lesions had first appeared on the face and, over the course of 2 months, had increased in size and number and were accompanied by malaise, fever, and loss of 6 kg of body weight ( Fig. 1 ). The presumptive clinical diagnosis was leishmaniasis, an endemic disease in the area where he lives. Laboratory parameters at presentation included the following: hemoglobin 11.5 g/dL; hematocrit 34%; white blood cells (WBC) total 7900 cells/mm³ ; lymphocytes total 1414 cells/mm³ ; platelets 449,000/mm³ ; CD4+ lymphocytes 1.5% and CD8+ lymphocytes 81.0%, with a CD4/CD8 ratio of 0.18 cells/mm^3. Blood chemistry, hepatic function tests, and serum electrolyte determinations were all within normal ranges. A chest roentgenogram was also normal. Human immunodeficiency virus (HIV) seropositivity was tested by enzyme‐linked immunosorbent assay (ELISA) and confirmed by Western blot.

Figure 1 Open in figure viewer PowerPoint Initial lesions: nodules, ulcers, and verrucous lesions involving the face