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Case Reports

Abstract

A 63-year old male with history of renal transplant presented to the emergency department with a 10-day history of a progressive fatigue, cough, dyspnea on exertion, and multiple 3-6mm asymptomatic skin-colored umbilicated papules on the face, neck, trunk, and arms.  The lesions were reminiscent of widespread molluscum contagiosum.  The patient had traveled to Minnesota one month before admission. Punch biopsies revealed large aggregates of yeast forms both intracellularly within histiocytes and extracellularly that were uniform in size with perinuclear clearing. GMS and PASd stains highlighted the yeast forms. Serologies ultimately were positive for Histoplasma (serum and urine). Despite being treated with Amphotericin B after a diagnosis of disseminated histoplasmosis, the patient developed multiorgan failure and expired. Disseminated histoplasmosis is a systemic disease caused by dimorphic fungi Histoplasma capsulatum. Histoplasma spp. are found in all continents and endemic to the USA's midwest region. The disease commonly presents with an influenza-like illness. Skin manifestations of histoplasmosis are uncommon, varying in appearance from hyperpigmented to erythematous papules and nodules. Molluscum contagiosum-like umbilicated lesions are an unusual clinical manifestation of this infection.  This case underscores the importance of maintaining a comprehensive differential diagnosis, especially in immunocompromised patients, when evaluating widespread molluscoid lesion.