Primary Cutaneous Histoplasmosis of the Face in an Elderly Immunocompetent Male: A Case Report

Histoplasma capsulatum causes histoplasmosis, a systemic fungal infection that is relatively uncommon in India. Cutaneous involvement is rare, manifesting as papules to erythema nodosum, with few cases reported from Delhi between 1994 and 2017. A 76-year-old immunocompetent male presented with a 3-month history of facial lesions. Dermoscopy revealed a central yellowish crateriform plug with surrounding yellow-white areas, linear telangiectasia and erythema. Punch biopsy showed intracellular yeast forms on Periodic acid–Schiff staining, consistent with H. capsulatum . Systemic evaluation ruled out dissemination. Oral itraconazole led to clinical improvement within 3 weeks. Primary cutaneous histoplasmosis confined to the face is often underdiagnosed in elderly immunocompetent patients with multiple nodular lesions. This case underscores the value of dermoscopy and histopathology for early diagnosis of deep fungal infections in atypica facial lesions, especially in endemic regions.