CUTANEOUS HISTOPLASMOSIS AS OPPORTUNISTIC INITIAL INFECTION IN AIDS

A 55-year-old homosexual Indonesian (last stay in Indonesia 2 years pr eviously), known to be HIV positive since 1986, developed desquamating , in part ulcerating, skin eruption over the face and shoulder region. On admission his temperature was 38.2-degrees-C, erythrocyte sediment ation rate 72/95 mm, white cell count 3.100/mul, and the CD4 cell coun t 30/mul. Examination of lung, oesophagus, stomach, duodenum and colon for possible opportunistic infections was negative. Fundoscopy reveal ed an infiltrate in the right eye with destruction of the vitreous. Sk in biopsy suggested histoplasmosis, confirmed by culturing H. capsulat um varietas capsulatum. It is likely that this was the reactivation of a latent, previously symptom-free infection, in this case the first o pportunistic infection in the presence of AIDS. For 30 days he receive d infusions of amphotericin B (initially 0.1 mg/kg daily, after the 5t h day 0.5 mg/kg), resulting in rapid healing of the skin lesions. Subs equently he has received (for 6 months so far) itraconazole, 400 mg da ily, without further complications.