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Primary Cutaneous Histoplasmosis in a Renal Allograft Recipient

NINOO GEORGE G CGEORGE

Abstract


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
anyother organ involvement. Skin biopsy
revealed septal granulomatous panniculitis
with focal lobular extension and
occasional yeast-like fungi. The tissue
was sent for microbiological analysis
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.


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