Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: case report and literature review

Batista, Jéssica Mauricio; Martins, Maria Auxiliadora Parreiras; Bertollo, Caryne Margotto

doi:10.31744/einstein_journal/2021RC5488

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Case Report • Einstein (São Paulo) 19 • 2021 • https://doi.org/10.31744/einstein_journal/2021RC5488 copy

Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: case report and literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum. The disease is endemic in several regions of tropical and temperate climate. The fungus presents opportunistic behavior, causing widespread infection in immunocompromised patients, resulting from complication of primary pulmonary infection, due to exogenous reinfection or reactivation of a quiescent source. In immunocompetent individuals, approximately 95% of pulmonary infections are asymptomatic. However, prolonged exposure to high amount spores may lead to acute or chronic lung infection. Due to the low amount of inoculum, primary cutaneous histoplasmosis caused by traumatic implantation is extremely rare and effectively treated with triazoles. Thus, the present study aims to report a case of primary cutaneous histoplasmosis that is difficult to treat in an immunocompetent patient, and to review the literature on the incidence of drug-resistant Histoplasma capsulatum strains in clinical practice.

Keywords:
Histoplasmosis; Histoplasma; Immunocompetence; Itraconazole

Study	Type	Sex	Age (years)	Treatment	Lesion	Remission (weeks)	Comments
Saheki et al.⁽¹1. Saheki MN, Schubach AO, Salgueiro MM, Conceição-Silva F, Wanke B, Lazera M. Histoplasmose cutânea primária: relato de caso em paciente imunocompetente e revisão de literatura. Rev Soc Bras Med Trop. 2008;41(6):680-2.⁾	Case report and review	Male	45	Itraconazole	Single	6	Patient with erythematous papular-tuberous lesion on the dorsum of the right hand. Treatment with itraconazole (400mg/day, PO)
Paixão et al.⁽⁶6. Paixão M, Miot HA, Avancini J, Belda Júnior W. Primary cutaneous histoplasmosis developed in the penis of an immunocompetent patient. An Bras Dermatol. 2015;90(2):255-7.⁾	Case report	Male	70	Itraconazole	Multiple	4	Patient with erythematous genital lesions. Treatment with itraconazole (200mg/day, PO)
Raina et al.⁽⁷7. Raina RK, Mahajan V, Sood A, Saurabh S. Primary cutaneous histoplasmosis in an immunocompetent host from a nonendemic area. Indian J Dermatol. 2016;61(4):467.⁾	Case report	Male	32	Liposomal amphotericin B	Single	3	Patient with ulcerated lesion on the right thigh. Treatment with liposomal amphotericin B (3mg/kg/day)
Bhattacharya et al.⁽⁸8. Bhattacharya JB, Rani P, Aggarwal R, Kaushal S. Primary cutaneous histoplasmosis masquerading as lepromatous leprosy. J Clin Diagn Res. 2017;11(1):ED01-ED02.⁾	Case report	Male	70	Fluconazole	Multiple	NR	Patient with nodular lesions on the face, head, neck, and trunk. Posology not reported.
Patra et al.⁽⁹9. Patra S, Nimitha P, Kaul S, Valakkada J, Verma KK, Ramam M, et al. Primary cutaneous histoplasmosis in an immunocompetent patient presenting with severe pruritus. Indian J Dermatol Venereol Leprol. 2018;84(4):465-8.⁾	Case report	Male	60	Liposomal amphotericin B and itraconazole	Multiple	8	Patient with erythematous papular lesions on the trunk, face, and upper limbs. Treatment with liposomal amphotericin B (3mg/kg/day) for 8 days, followed by itraconazole (400mg/day, PO)

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[1] Corresponding author: Caryne Margotto Bertollo, Avenida Presidente Antônio Carlos, 6.627, room 3026, building B2 – Pampulha, Zip code: 31270-901 – Belo Horizonte, MG, Brazil. Phone: (55 31) 3409-6941 E-mail: carynemb@gmail.com