Cutaneous histoplasmosis with prominent parasitization of epidermal keratinocytes: report of a case
Hedieh H. Honarpisheh
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Pathology, Duke University School of Medicine, Durham, NC, USA
Search for more papers by this authorJonathan L. Curry
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorKristen Richards
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorPriyadharsini Nagarajan
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorPhyu P. Aung
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCarlos A. Torres-Cabala
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorDoina Ivan
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCarol R. Drucker
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorRichard Cartun
Department of Pathology, Hartford Hospital, Hartford, CT, USA
Search for more papers by this authorVictor G. Prieto
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCorresponding Author
Michael T. Tetzlaff
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Michael T. Tetzlaff
Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
Tel: (713)-792-2585
Fax: (713)-745-0778
e-mail: [email protected]
Search for more papers by this authorHedieh H. Honarpisheh
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Pathology, Duke University School of Medicine, Durham, NC, USA
Search for more papers by this authorJonathan L. Curry
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorKristen Richards
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorPriyadharsini Nagarajan
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorPhyu P. Aung
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCarlos A. Torres-Cabala
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorDoina Ivan
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCarol R. Drucker
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorRichard Cartun
Department of Pathology, Hartford Hospital, Hartford, CT, USA
Search for more papers by this authorVictor G. Prieto
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorCorresponding Author
Michael T. Tetzlaff
Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Translational and Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Michael T. Tetzlaff
Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
Tel: (713)-792-2585
Fax: (713)-745-0778
e-mail: [email protected]
Search for more papers by this authorAbstract
Disseminated histoplasmosis most commonly occurs in immunosuppressed individuals and involves the skin in approximately 6% of patients. Cutaneous histoplasmosis with an intraepithelial-predominant distribution has not been described.
A 47-year-old man was admitted to our institution with fever and vancomycin-resistant enterococcal bacteremia. He had been diagnosed with T-cell prolymphocytic leukemia 4 years earlier and had undergone matched-unrelated-donor stem cell transplant 2 years earlier; on admission, he had relapsed disease. His medical history was significant for disseminated histoplasmosis 6 months before admission, controlled with multiple antifungal regimens. During this final hospitalization, the patient developed multiple 2–5 mm erythematous papules, a hemorrhagic crust across the chest, shoulders, forearms, dorsal aspect of the fingers, abdomen and thighs. Skin biopsy revealed clusters of oval yeast forms mostly confined to the cytoplasm of keratinocytes and within the stratum corneum; scattered organisms were present in the underlying superficial dermis without any significant associated inflammatory infiltrate. Special stains and immunohistochemical studies confirmed these to be Histoplasma organisms.
We highlight this previously unrecognized pattern of cutaneous histoplasmosis to ensure its prompt recognition and appropriate antifungal therapy.
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