| dc.description.abstract | Histoplasma capsulatum is a soil saprophyte which is now considered to be endemic in Southeast
Asia and Southern Europe. It is a thermally dimorphic fungus seen in damp soil contaminated
with bat guano and bird excreta. Here we present a case of disseminated histoplasmosis, which
is rarely encountered in the Sri Lankan clinical setting. 57-year-old farmer presented to Army
hospital Colombo 05 with painful, pus discharging multiple nodular lesions on face, upper limbs,
and trunk for one month. He had oral mucosal lesions with oral swelling and he complained of
dysphagia, loss of appetite and loss of weight. He had been treated for Histoplasma capsulatum
infection four years ago in a different hospital but had defaulted treatment. This patient had been
exposed to caves with bats in their village which can be considered as the source of his infection.
In this admission histopathology of forehead nodular lesion was compatible with Histoplasma
infection. KOH direct smear of biopsy samples from R/axillary nodules showed numerous
budding yeast cells and culture isolated Histoplasma capsulatum at the Mycology Reference
Laboratory. CECT revealed numerous foci of calcification in the pancreatic head, body, and tail
region with a large amorphous calcification (32mm x 22mm x 16mm) in the tail region. No other
organs were involved. He was managed as disseminated histoplasmosis, with IV amphotericin B
and oral itraconazole to which he achieved an adequate clinical response. Histoplasmosis should
be suspected in patients with granulomatous skin lesions, and prompt diagnosis and prolonged
antifungal treatment with close follow up will result in favourable outcomes in these patients. | en_US |
