PMC4347388_01
(A) Generalized nodule-ulcerative lesions characteristic of chronic progressive disseminated histoplasmosis. (B) On the right arm, there are multiple skin-colored umbilicated papules, hemorrhagic crusts, and ulcerated nodules. (C) CT of the mediastinum showing pretracheal and hilar calcified lymph nodes. (D) Photomicrograph of the pathologic specimen stained with periodic acid-Schiff shows numerous histiocytes and extracellular yeasts of H. capsulatum (magnification, x400).
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F1
He denied fever and chills, but a few days after initial symptoms began, he presented erythematous papules and ulcers on the body trunk that subsequently spread to the extremities (Figure 1A and B). Computed tomography (CT) showed a stippled calcification on mediastinal lymph nodes (Figure 1C). It was after a second skin biopsy that the presence of yeasts consistent with histoplasmosis was finally seen (Figure 1D ).
(Left) Healed lesions are observed a few months after starting treatment with itraconazole. (Right) Skin lesions were replaced by scars and some hyperpigmented spots.
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F2
He was started on itraconazole (400 mg/day), and 4 months later, his symptoms improved (Figure 2 ).