Thread by @guerreroespejo

A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?
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#IDTwitter #microbiology

🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.

PROGRESSIVE DISSEMINATED HISTOPLASMOSIS
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doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine

Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate
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#MedTwitter #Doctor

Intravenous deoxycholate amphotericin B and itraconazole prophylaxis in view of low CD4 cell counts. The treatment cycle of amphotericin B was repeated after 3 weeks.

Fever subsided, general condition improved & he was free of skin lesions
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#MedStudentTwitter #medicine

The disease is endemic in North America, Central and South America.
However, the disease is being reported frequently from nonendemic areas as well especially among immunocompromised individuals and returning travelers
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#MedicalStudents #MedEd

This immunecompromised patient, taking treatment for suspected pulmonary tuberculosis without benefit, had classic progressive disseminated histoplasmosis presenting with pulmonary histoplasmosis and widespread cutaneous involvement.

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#bacteriology #dermatology

In immunocompetent hosts, when disseminated histoplasmosis occurs from pulmonary infection, oral ulcers, nodules, & vegetative plaques are common, and dissemination to liver, spleen, bone marrow, & other organs is frequent
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doi: 10.4269/ajtmh.17-0432
#resident #dermtwitter