Histoplasmosis: A Rare Cause of Granulomatous Cutaneous Disease

Introduction: Histoplasma capsulatum is the causative agent of the mycotic infection histoplasmosis. Histoplasmosis is uncommon in India. Only 13 of the 144 cases of histoplasmosis in India that were included in a review of reports published between 1994 and 2017 came from Delhi. Up to 17% of histoplasmosis patients have cutaneous lesions, which can range from papules to erythema nodosum. Here, we describe a rare case of granulomatous cutaneous disease diagnosed as primary cutaneous histoplasmosis on histopathology. Case Report: A 56-year-old male car mechanic presented with a one-and-a-half-month history of small, pinhead-sized raised lesions over the cheeks and forehead, which increased in size and character to involve the chest, abdomen, and both arms. A skin biopsy was done. Microscopically, the biopsy revealed granulomatous inflammation. Various investigations identified intracellular and extracellular fungi in capsulated yeast forms, which were proven to be Histoplasma capsulatum. Conclusion: An opportunistic fungal infection that is more prevalent in immunocompromised people is histoplasmosis. It has varied presentations, including pulmonary, progressive disseminated, chronic cavitatory, and primary cutaneous forms. Primary cutaneous histoplasmosis is a very rare condition, and we have hereby reported such a case.