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Primary Cutaneous Histoplasmosis in a Renal Allograft Recipient



The occurrence of histoplasmosis
in renal allograft recipients is quite
rare. While cutaneous involvement secondary
to histoplasmosis has been reported
in up to 17 percent of patients
with disseminated disease, the occurrence
of isolated cutaneous involvement
is extremely rare. In this report, we describe
the occurrence of primary cutaneous
histoplasmosis involving the thigh in
a renal allograft recipient. A 27 year old
lady, who underwent renal transplantation
9 years ago, presented to us with
complaints of painful swelling of her right
thigh for 3 months. She noticed small
nodular, erythematous lesions on the lateral
aspect of her right thigh, which
gradually increased in size and coalesced
to form a diffuse erythematous
swelling. There was no history of fever or
trauma. She had diarrhea for 3 months,
which subsided after discontinuation of
mycophenolate mofetil. There was no
history to suggest any other organ involvement.
Skin biopsy revealed septal
granulomatous panniculitis with focal
lobular extension and occasional yeastlike
fungi. The tissue was sent for microbiological
which revealed Histoplasma capsulatum.
After a thorough workup to rule out disseminated
histoplasmosis, she was started
on oral itraconazole in renal adjusted
doses. The lesions started resolving in 1
week. The patient was advised to continue
itraconazole for at least one year. However,
due to financial constraints, she
stopped the medication after 3 months.
However, the lesions had completely resolved,
with no recurrence till the last follow
-up visit.

Full Text:



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