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Skin lesion of histoplasmosis

 

Definition

Skin lesions of histoplasmosis are a symptom of widespread infection with the fungus Histoplasma capsulatum.

Causes

Histoplasmosis is a fungal infection. It occurs all over the world.

Histoplasma fungus grows in soil. When particles become airborne, they can be breathed into the lungs, causing infection. Soil contaminated with bird or bat droppings may have a higher concentration of the fungus.

After infecting the lungs, the fungus travels (disseminates) to distant organs throughout the body, including the skin, the bone marrow, and the brain. This is most common in immunosuppressed people, such as those with AIDS or cancer, or those who have had a transplant.

Skin lesions can be caused by an immune response to the infection (usually a rash called erythema nodosum or erythema multiforme), or by the fungus itself when it spreads to the skin.

Symptoms

The symptoms may include:

  • Mouth ulcer, usually painless
  • Pustules or nodules all over the body
  • Symptoms related to the erythema nodosum and erythema multiforme rashes
Signs and tests

In some cases, a biopsy of the skin lesion can identify the fungus. On the other hand, erythema nodosum and erythema multiforme are inflammatory reactions and usually do not have fungus in them. A urine test may help detect the fungus in some cases.

Support Groups

Expectations (prognosis)

The outlook depends on the form of histoplasmosis and the condition of the individual's immune system. Death can occur in some cases.

Calling your health care provider

The skin lesions may be similar to skin problems from other infections or illnesses. Notify your health care provider if you develop any suspicious lesions on your skin, so that you may be tested correctly.

Complications
  • Bacterial skin infection
  • Complications of medications (for example, amphotericin B can have severe, unpleasant side effects)
Treatments

Antifungal drugs, such as amphotericin B, itraconazole, and ketoconazole, are the usual treatments. Antifungals may be given intravenously depending on the form or stage of disease. In some cases, long-term treatment with antifungal drugs may be needed.

Prevention

Histoplasmosis may be prevented by reducing exposure to dust in chicken coops, bat caves, and other high-risk locations. Wear masks and other protective equipment if you work in these environments.

References

Kauffman CA. Histoplasmosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 353.


Review Date: 9/28/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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