The Many Faces of Disseminated Emergomyces Africanus

Disseminated emergomycosis, caused by Emergomyces africanus, is an emerging opportunistic fungal infection affecting individuals with advanced HIV in Southern Africa. We report a 37-year-old woman with untreated advanced HIV who initially presented with community-acquired pneumonia, followed by fever, weakness and a morbilliform eruption 2 weeks later, diagnosed as a cutaneous adverse drug reaction. Subsequent admission with septic shock 2 days later, with a negative infectious work-up, eosinophilia, liver dysfunction, and supportive histopathology, favoured a drug reaction with eosinophilia and systemic symptoms (DRESS). During admission, she developed dome-shaped facial papules, initially considered lichen myxoedematosus. Following antiretroviral therapy, she deteriorated with progression of the facial lesions and new hemorrhagic papules, raising suspicion for disseminated fungal infection with unmasking immune reconstitution inflammatory syndrome. Fungal organisms were demonstrated in all 3 skin biopsies, with culture and tissue polymerase chain reaction confirming Emergomyces africanus. This case highlights the protean cutaneous manifestations of disseminated emergomycosis and the importance of repeated clinicopathological reassessment.