CLINICAL IMAGES

 

Skin and mucosal manifestations of an AIDS-related systemic mycosis

 

 

Michael T. Boswell^{I, II}; Liam Robinson^III; Nelesh Govender^{IV, V}

^IDepartment of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
^IIDepartment of Internal Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
^IIIDepartment of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
^IVCentre for HAIs, AMR and Mycoses, National Institute for Communicable Diseases, Johannesburg, South Africa
^VFaculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Correspondence

 

 

A human immunodeficiency virus (HIV)-positive male from Cameroon who had recently started antiretroviral therapy presented with a new rash, night sweats and loss of weight. On examination, erythematous to flesh-coloured papules were noted on the trunk (a). Intraoral examination revealed granular-appearing lesions of the hard and soft palate, with areas of pigmentation in keeping with HIV-associated mucosal hyperpigmentation (b). A full blood count showed a pancytopenia, with a moderate neutropenia. He had a severe lymphopenia, and his CD4+ T-cell count was 46 cells/microlitre (µL). Serum (1-3)-β-d-glucan and ferritin levels were markedly elevated at > 500 picograms per millilitre (pg/mL) and 5533 micrograms per litre (µg/L), respectively. Periodic Acid-Schiff with Diastase (PAS-D) and Grocott-Gomori histochemical stains of a skin punch biopsy showed numerous small, round intracytoplasmic organisms within histiocytes, consistent with histoplasmosis (c and d) (see Figure 1). A pan-fungal polymerase chain reaction (PCR) assay confirmed infection with either Histoplasma capsulatum or Emergomyces africanus. This PCR assay cross-reacts with Blastomyces species; however, the yeast phase of this pathogen has a different histological appearance.

 

Acknowledgements

The authors would like to thank Theresa Rossouw, Tarryn Jacobs and Glynn Dale Buchanan for their help on earlier versions of this manuscript and input on the management of this case.

Competing interests

The authors have declared that no competing interests exist.

Authors' contributions

All authors contributed to the case management and drafting of this manuscript.

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Data availability statement

Data sharing is not applicable to this article, as no new data were created or analysed in this study.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

 

 

Correspondence:
Michael Boswell
boswell.michaelt@gmail.com

Received: 23 Nov. 2020
Accepted: 09 Dec. 2020
Published: 28 Jan. 2021