Progressive Disseminated Histoplasmosis in an Immunocompetent Host with Reversible CD4 Lymphocytopenia

Pratap Singh, Sanjay Kumar, Pramila Dharmshaktu, Dinesh Meher, Vijay Kumar


We report an 18-year-old male patient presented to us with complaints of fever and progressive weight loss for past 4 months. On examination, he also had multiple umbilicated papular to nodular lesions over his chin and forehead region. Blood count revealed anemia with leukopenia. An excisional biopsy of the skin lesion was suggestive of cutaneous histoplasmosis. On further investigations for anemia and leukopenia, he was found to have bone marrow histoplasmosis on trephine biopsy. Patient’s serology for HIV I and II was negative but his CD4 counts were low. Patient received amphotericin B and itraconazole. He showed remarkable improvement in his general condition and blood counts. A repeat CD4 count done at 4 months of treatment was also normal. Progressive disseminated histoplasmosis (PDH) presenting as cutaneous lesions in an immunocompetent host is very rare and has been reported in a few cases only.


Progressive disseminated histoplasmosis, reversible CD4 depletion.

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