Primary Cutaneous Histoplasmosis in an Immunocompetent Patient: A Case Report

Background: Primary cutaneous histoplasmosis (PCH) is a rare manifestation with a very few documented cases in literature of Histoplasmacapsulatum infection caused by direct inoculation of fungal organisms into the skin, especially in immunocompetent individuals. It can often mimic benign or inflammatory skin lesions, leading to diagnostic dilemmas. Case presentation: A 76-year-old immunocompetent farmer who presented to the OPD with complaints of multiple mildly itchy nodules on face for 2.5 months, few of them showing discharging sinuses. Histopathology demonstrated numerous intrahistiocytic yeasts highlighted by Periodic acid–Schiff stain, consistent with histoplasmosis. Systemic evaluation was negative for any signs of disseminated disease. The patient was managed with oral itraconazole and incision and drainage with expected favorable outcome. This case highlights the need to consider PCH in elderly patients presenting with new nodular or umbilicated facial lesions. Conclusion: Primary cutaneous histoplasmosis should be considered in elderly immunocompetent patients presenting with unexplained nodular, umbilicated, or plaque-like facial lesions. Early biopsy with fungal stains is essential for diagnosis and helps avoid unnecessary antibacterial or antitubercular therapy. Prompt treatment with itraconazole generally leads to favorable outcomes.

Keywords: Primary Cutaneous Histoplasmosis.