Disseminated Histoplasmosis Due to Histoplasma capsulatum var. duboisii in a Non-HIV Patient in Togo: A Case Report

Background : Histoplasmosis is a fungal infection due to Histoplasma capsulatum . We report a case of disseminated African histoplasmosis in an HIV uninfected patient in Togo. Case Report : A 35-year-old woman was admitted in dermatology for disseminated nodular lesions and left shoulder pain for 4 months. On examination, there were firm or softened nodular lesions with torpid ulceration and translucent molluscoid-like papules disseminated on the face, trunk, and limbs. There was also a painful swelling of the left shoulder, with an impotent upper limb. Histology showed an acanthotic epidermis discretely keratotic. In the dermis, there were granulomas with giant cells, histiocytes and polymorphonuclear cells around largely altered yeasts. The presence of Histoplasma capsulatum var. duboisii was confirmed by direct microscopic examination. Chest X-ray showed a left minimal abundance pleurisy. Shoulder x-ray showed heterogeneous lysis of the left humeral head and a large osteopenia of bones associated with left scapulo-humeral dislocation. The medical treatment was based on itraconazole (400mg/day) for 4 months relieved by fluconazole (450 mg/day) with good evolution after 4 months. Conclusion : A disseminated form of African histoplasmosis can be observed in non-HIV infected patients. The prognosis depends on the precocity of the diagnosis and the treatment.