Disseminated Histoplasmosis in an Untreated Human Immunodeficiency Virus Patient

Histoplasmosis is an opportunistic fungal infection caused by Histoplasma capsulatum which is transmitted by inhalation. Human Immunodeficiency Virus (HIV) patients with CD4 levels <150 cells/mm3 have a high risk of infection and high mortality rate if not treated immediately. Here we reported a case of a male patient who had previously been diagnosed with HIV but had not received antiretroviral therapy with a complaint of redness on his hands and feet which then spread all over the body and then become dark. Other complaints include subfebrile fever, weakness, diarrhea, no appetite, and weight loss. On skin examination, there were papules, hyperpigmented plaques with blackish crusts, lenticular, nummular, irregular with erosions and excoriations on it. Absolute CD4 T-lymphocyte count 2 cells/mm3, HIV-1 RNA 86220 copies/mL, and punch biopsy from skin lesions showed H. capsulatum. The patient received cotrimoxazole, antiretroviral and antifungal therapy (amphotericin-B deoxycholate followed by itraconazole). After giving antifungal therapy for two months there was clinical improvement in the skin lesion. Disseminated histoplasmosis is one of the opportunistic infections that can be found in HIV patients. If the diagnosis can be made quickly and appropriate antifungal therapy could reduce morbidity and mortality, in addition to antiretroviral therapy as the main therapy for HIV infection.