case_images: PMC4347388_01
case_images: (A) Generalized nodule-ulcerative lesions characteristic of chronic progressive disseminated histoplasmosis. (B) On the right arm, there are multiple skin-colored umbilicated papules, hemorrhagic crusts, and ulcerated nodules. (C) CT of the mediastinum showing pretracheal and hilar calcified lymph nodes. (D) Photomicrograph of the pathologic specimen stained with periodic acid-Schiff shows numerous histiocytes and extracellular yeasts of H. capsulatum (magnification, x400).
case_images: tropmed-92-4-g001.jpg
case_images: PMC4347388_01_tropmed-92-4-g001.jpg
case_images: F1
case_images: He denied fever and chills, but a few days after initial symptoms began, he presented erythematous papules and ulcers on the body trunk that subsequently spread to the extremities (Figure 1A and B). Computed tomography (CT) showed a stippled calcification on mediastinal lymph nodes (Figure 1C). It was after a second skin biopsy that the presence of yeasts consistent with histoplasmosis was finally seen (Figure 1D ).
case_images: (Left) Healed lesions are observed a few months after starting treatment with itraconazole. (Right) Skin lesions were replaced by scars and some hyperpigmented spots.
case_images: tropmed-92-4-g002.jpg
case_images: PMC4347388_01_tropmed-92-4-g002.jpg
case_images: F2
case_images: He was started on itraconazole (400 mg/day), and 4 months later, his symptoms improved (Figure 2 ).