DISSEMINATED HISTOPLASMA-CAPSULATUM INFECTION PRESENTING AS GENITAL ULCERATIONS

Background: Histoplasma capsulatum infection in adults is most often s ubclinical but can result in disseminated disease with weight loss, fe ver, hepatosplenomegaly, and oropharyngeal ulcerations. Genital ulcera tion as the presenting sign of the disease has been reported rarely. C ase: A 63-year-old woman presented with multiple vaginal ulcerations d ue to chronic disseminated H capsulatum infection. Initial diagnosis w as made by Papanicolaou and Giemsa-stained vulvar smears. Ketoconazole therapy resulted in clearing of the lesions in 5 weeks. Conclusion: C hronic disseminated histoplasmosis is an insidious and potentially fat al disease that can present rarely as genital mucocutaneous ulceration s in women. Prompt presumptive diagnosis can be accomplished by examin ation of smears obtained by ulcer abrasion, permitting institution of appropriate therapy. (C) 1997 by the American College of Obstetricians and Gynecologists.