Primary Cutaneous Histoplasmosis in a Renal Allograft Recipient

The occurrence of histoplasmosis in renal allograft recipients is quite rare. While cutaneous involvement secondary to histoplasmosis has been reported in up to 17 percent of patients with disseminated disease, the occurrence of isolated cutaneous involvement is extremely rare. In this report, we describe the occurrence of primary cutaneous histoplasmosis involving the thigh in a renal allograft recipient. A 27 year old lady, who underwent renal transplantation 9 years ago, presented to us with complaints of painful swelling of her right thigh for 3 months. She noticed small nodular, erythematous lesions on the lateral aspect of her right thigh, which gradually increased in size and coalesced to form a diffuse erythematous swelling.There was no history of fever or trauma. She had diarrhea for 3 months, which subsided after discontinuation of mycophenolate mofetil. There was no history to suggest anyother organ involvement. Skin biopsy revealed septal granulomatous panniculitis with focal lobular extension and occasional yeast-like fungi. The tissue was sent for microbiological analysis which revealed Histoplasma capsulatum. After a thorough workup to rule out disseminated histoplasmosis, she was started on oral itraconazole in renal adjusted doses. The lesions started resolving in 1 week. The patient was advised to continue itraconazole for at least one year. However, due to financial constraints, she stopped the medication after 3 months. However, the lesions had completely resolved, with no recurrence till the last follow-up visit.