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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.86 no.5 Rio de Janeiro Sept./Oct. 2011
IMAGENS EM DERMATOLOGIA TROPICAL
Histoplasmosis and AIDS co-infection*
Ana Tereza OrsiI; Lisiane NogueiraII; Anette Chrusciak-TalhariIII; Monica SantosIII; Luiz Carlos de Lima FerreiraIV; Sinesio TalhariV; Carolina TalhariVI
IDermatologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil
IIDermatology Resident at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil
IIIPhD in Tropical Medicine, Dermatologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil
IVPhD in Pathology, Pathologist at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil
VPh.D. in Dermatology, Director of the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil
VIPh.D., Professor of Dermatology at the State University of Amazonas
This report concerns an AIDS patient presenting systemic and cutaneous manifestations of histoplasmosis. A histopathological and mycological examination of the skin lesion confirmed the diagnosis. In AIDS patients histoplasmosis arises mainly when the T-CD4+ cell count is less than 50 cells/mm3. In such cases, histoplasmosis can be severe and if left untreated can lead to death, as occurred with this patient.
Keywords: AIDS-Related Opportunistic infections; Acquired immunodeficiency syndrome; HIV; Histoplasma; Histoplasmosis
Histoplasmosis is caused by Histoplasma capsulatum var. Capsulatum. In patients with AIDS it occurs mainly when the T-CD4-positive cell count is less than 50 cells/ mm3. In such cases,this mycosis can be severe and if left untreated can lead to a lethal outcome, as in the patient reported here. 2.3 Clinical symptoms may include fever, hepatosplenomegaly, lymphadenopathy, pulmonary manifestations, skin and mucosal lesions and central nervous system involvement. 3.4 Macular, purpuric, papular lesions (occasionally acneiform or molluscum contagiosum-like), plaques and ulcers can occur together or in isolation (Figures 1 and 2). Erosive lesions or ulcers can occur in the oral mucosa. 4-7 Diagnosis is made by direct examination, culture and histopathology (Figures 3 and 4). The treatment of severe cases (T-CD4+ counts of below 100 cells/ mm3 and/or general state of health compromised) consists of amphotericin B (1mg/kg) until complete regression of clinical symptoms, followed by maintenance with fluconazole or itraconazole (200-300 mg/day) until the T-CD4+ count reach es 150 cells/mm3.1,4-7
1. Bonifaz A, Chang P, Moreno K, Fernández-Fernández V, Montes de Oca G, Araiza J, Ponce RM. Disseminated cutaneous histoplasmosis in acquired immunodeficiency syndrome: report of 23 cases. Clin Exp Dermatol. 2009;34:481-6. [ Links ]
2. Souza SL, Feitoza PV, Araújo JR, Andrade RV, Ferreira LC. Causes of death among patients with acquired immunodeficiency syndrome autopsied at the Tropical Medicine Foundation of Amazonas. Rev Soc Bras Med Trop. 2008;41:247-51. [ Links ]
3. Gon AS, Franco C, Maia IL, Rodrigues VSM, Pozzeti EMO, Antônio JR. Histoplasmose cutânea na síndrome de imunodeficiência adquirida - relato de 4 casos. An Bras Dermatol. 1992;67:221-6. [ Links ]
4. Talhari C, Braga A, Chrusciak-Talhari A, Niedermeier A, Carlos Ferreira L, Talhari S. Cutaneous ulcer due to histoplasmosis and HIV infection. Hautarzt. 2009;60:992-4. [ Links ]
5. Cunha VS, Zampese MS, Aquino VR, Cestari TF, Goldani LZ. Mucocutaneous manifestations of disseminated histoplasmosis in patients with acquired immunodeficiency síndrome: particular aspects in a Latin- American population. Clin Exp Dermatol. 2007;32:250-5. [ Links ]
6. Talhari C, Talhari S, Massone C. Widespread crusted lesions in a patient with HIV-quiz case. Arch Dermatol. 2009;145:1447-52. [ Links ]
7. Porro AM, Yoshioka MCN. Manifestações dermatológicas da infecção pelo HIV. An Bras Dermatol. 2000;75:665-91. [ Links ]
Mailing address: Received on 31.01.2010. * Study conducted at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil.
Av. Via Láctea, 1085, apt 300, Aleixo
69060-085 Manaus - AM, Brazil
Approved by the Advisory Board and accepted for publication on 16.07.2010.
Conflict of interest: None
Financial funding: Amazonas Tropical Medicine Foundation
Received on 31.01.2010.
* Study conducted at the Amazonas Tropical Medicine Foundation (FMTAM), Manaus (AM), Brazil.