Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS
Abstract Background Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07351-0 |
| _version_ | 1818274489557843968 |
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| author | Luis Escalante Jennyfer Granizo-Rubio Victor Pinos-León Sonia Tello Astrid Maldonado Iván Cherrez-Ojeda |
| author_facet | Luis Escalante Jennyfer Granizo-Rubio Victor Pinos-León Sonia Tello Astrid Maldonado Iván Cherrez-Ojeda |
| author_sort | Luis Escalante |
| collection | DOAJ |
| description | Abstract Background Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. Case presentation We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. Conclusions Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months. |
| first_indexed | 2024-12-12T22:14:40Z |
| format | Article |
| id | doaj.art-a2d745b2e65c43b2b81bf9f36a71bbe3 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T22:14:40Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-a2d745b2e65c43b2b81bf9f36a71bbe32022-12-22T00:10:08ZengBMCBMC Infectious Diseases1471-23342022-04-012211510.1186/s12879-022-07351-0Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDSLuis Escalante0Jennyfer Granizo-Rubio1Victor Pinos-León2Sonia Tello3Astrid Maldonado4Iván Cherrez-Ojeda5Unit of Dermatology, Central University of EcuadorEugenio Espejo HospitalDerma AidDepartment of Pathology, Hospital AxxisUnit of Dermatology, Central University of EcuadorUniversidad Espíritu SantoAbstract Background Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. Case presentation We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. Conclusions Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.https://doi.org/10.1186/s12879-022-07351-0Case reportHistoplasmosisHIVAIDSNasal cartilage destruction |
| spellingShingle | Luis Escalante Jennyfer Granizo-Rubio Victor Pinos-León Sonia Tello Astrid Maldonado Iván Cherrez-Ojeda Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS BMC Infectious Diseases Case report Histoplasmosis HIV AIDS Nasal cartilage destruction |
| title | Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS |
| title_full | Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS |
| title_fullStr | Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS |
| title_full_unstemmed | Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS |
| title_short | Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS |
| title_sort | nasal cartilage destruction associated to cutaneous histoplasmosis in aids |
| topic | Case report Histoplasmosis HIV AIDS Nasal cartilage destruction |
| url | https://doi.org/10.1186/s12879-022-07351-0 |
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