Disseminated histoplasmosis with skin manifestations in advanced HIV: Case report

Authors

  • Francisco Arreola-Banda <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33,&nbsp;Servicio de Medicina Interna.&nbsp;Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0002-1642-2657
  • Olivia López-Lachica <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0001-7688-6317
  • Guillermo García-Maldonado <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna, Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0002-9439-2609
  • Carlos Salvador Alcázar-Quiñones <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna, Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0002-0509-9444
  • Pedro Rodríguez-Alejandro <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Departamento de Investigaci&oacute;n y Educaci&oacute;n en Salud. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0005-6942-1692
  • Jorge Arturo Castillo-Meraz <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Departamento de Anatom&iacute;a Patol&oacute;gica. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p> http://orcid.org/0009-0004-4153-783X

DOI:

https://doi.org/10.5281/zenodo.10712236

Keywords:

Acquired Immunodeficiency Syndrome, HIV, Histoplasmosis

Abstract

Background: Histoplasmosis is a systemic mycosis caused by the agent Histoplasma capsulatum. Its clinical manifestations depend on the inhaled fungal load and can vary from an asymptomatic infection (90%) to a disseminated disease, especially in HIV infections and a CD4 T lymphocyte count of less than 150 cells. Its initial symptoms are nonspecific, including fever, weight loss, dry cough, and chest pain. It spreads to other organs, with the skin being a rare site where lesions of wide polymorphism are observed. The disseminated form requires a high index of suspicion and must be differentiated from other common pathologies in patients with advanced HIV infection such as pulmonary tuberculosis.

Clinic case: A 33-year-old male with a diagnosis of HIV/AIDS C3, pulmonary tuberculosis and dermatosis of 9 months' evolution, with poor adherence to treatment who died of complications secondary to disseminated histoplasmosis.

Conclusion: Histoplasmosis is a common opportunistic mycosis in patients with advanced HIV disease, especially in endemic areas, so it's recommended to start an early diagnostic protocol and raise awareness of the importance of adherence to treatment, due to the rapid progression of the disseminated variant and its high mortality.

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Author Biographies

  • Francisco Arreola-Banda, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33,&nbsp;Servicio de Medicina Interna.&nbsp;Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Médico Residente de Segundo año de Medicina Interna en Hospital General de Zona # 33, Monterrey, Nuevo Léon. 

     

  • Olivia López-Lachica, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Médico Residente de primer año de Medicina Interna en Hospital General de Zona # 33, Monterrey, Nuevo Léon. 

     

  • Guillermo García-Maldonado, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna, Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Médico Residente de primer año de Medicina Interna en Hospital General de Zona # 33, Monterrey, Nuevo Léon. 

  • Carlos Salvador Alcázar-Quiñones, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Servicio de Medicina Interna, Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Médico adscrito y profesor adjunto de Medicina Interna en Hospital General de Zona # 33, Monterrey, Nuevo Léon. 

  • Pedro Rodríguez-Alejandro, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Departamento de Investigaci&oacute;n y Educaci&oacute;n en Salud. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Especialista en Medicina de Urgencias y Coordinador de Educacion e Investigación en Salud en Hospital General de Zona # 33, Monterrey, Nuevo Léon. 

  • Jorge Arturo Castillo-Meraz, <p>Instituto Mexicano del Seguro Social, Hospital General de Zona No. 33, Departamento de Anatom&iacute;a Patol&oacute;gica. Monterrey, Nuevo Le&oacute;n, M&eacute;xico.</p>

    Especialista en  Anatomía Patológica en Hospital General de Zona #33, Monterrey, Nuevo León.

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Published

2024-03-27

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Section

Clinical Cases