Granulomatous skin lesions; a rare manifestation of histoplasmosis: A case report

Histoplasma capsulatum is a dimorphic fungus which can cause severe disease in humans. This case describes a patient with disseminated histoplasma infection with granulomatous skin lesions which is rarely encountered in Sri Lanka. A farmer who presented with multiple granulomatous nodules on face and upper trunk was found to be infected with Histoplasma capsulatum following isolation in fungal culture. He was diagnosed with histoplasmosis four years ago but had defaulted on treatment. He was treated with IV amphotericin B for 10 days and oral itraconazole for one year and achieved complete cure without any complications. Close contact with bat guano was considered as the source of his infection and measures were taken to prevent further exposure.   
Histoplasma infection needs to be ruled out in patients presenting with granulomatous cutaneous lesions as good clinical responses can be achieved by rapid diagnosis and appropriate therapy with antifungal drugs.