Disseminated Histoplasmosis Presenting as Mucocutaneous Lesions in an Immunocompetent Patient

A case of an immunocompetent male patient in his 50s, an oil field worker from the northeastern part of India who presented with fever, weight loss over 4 months, and multiple umbilicated papulonodular lesions on his face and nodular lesions over the hard palate, is reported. The initial suspicion was talaromycosis, which is endemic in that part of the country. Periodic acid-Schiff and Grocott-Gomori's methenamine silver staining of the skin biopsy specimen from the forehead revealed numerous yeast-like bodies morphologically resembling Histoplasma within the histiocytes. A culture of the skin biopsy grew Histoplasma capsulatum. The patient received liposomal amphotericin B (3 mg/kg/day) but later was shifted to oral itraconazole because of acute kidney injury. The patient exhibited improvement, with flattening of skin lesions and no development of new lesions during treatment. This case highlights histoplasmosis mimicking talaromycosis and the importance of tissue diagnosis for accurate identification.