CUTANEOUS DISSEMINATED HISTOPLASMOSIS IN AIDS PATIENTS IN SOUTH FLORIDA

Background Histoplasma capsulatum is a dimorphic pathogenic fungus end emic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may le ad to disseminated disease (disseminated histoplasmosis (DH)). It is o ne of the opportunistic infections which defines the acquired immunode ficiency syndrome (AIDS) and is rarely encountered outside endemic reg ions. Methods Clinical, laboratory, and histologic information concern ing seven patients with DH and AIDS in South Florida was recorded. Res ults We report seven cases of DH with mucocutaneous lesions in patient s infected with the human immunodeficiency virus (HIV). All patients h ad markedly depressed CD4 counts of less than 40 cells/mm(3), and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our pat ients had mucocutaneous lesions at the time of diagnosis, which clinic ally presented as a generalized papular eruption, ulcers, and erythema tous scaly plaques. Conclusions Even in non-endemic regions, HIV-posit ive patients presenting with fever, chills, weight loss, hepatosplenom egaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions shoul d have an early skin biopsy specimen taken for mycologic tissue cultur e and histopathologic evaluation for disseminated fungal infections.