Cutaneous Histoplasmosis in Child With Hyper Ig M Syndrome

Histoplasmosis is a disease caused by dimorphic fungus histoplasma capsulatum, commonly found in soil contaminated with bird or bat droppings or decay wood. Its route of transmission is through inhalation of aerosolized mycelial form. The organism remains in the mold (mycelial) form at soil temperatures and converts to the yeast form at human body temperature (37°C), where it resides within macrophages. The fungus is rapidly phagocytosed by macrophages and neutrophils but resists intracellular destruction. Intracellular yeast can disseminate through the lymphatics and bloodstream. Infected macrophages release cytokines to recruit additional macrophages and monocytes, which aggregate to form granulomas. A failure of the immune response results in the progressive spread of the infection to other organs. A 7-year-old female with history of intermittent fever for 8 months, multiple joint pain and weight loss for 2 months. On examination, she had pallor, erythematous plaque on face and hepatosplenomegaly. The patient had high levels of immunoglobulins and reduced CD4, CD8 count. cutaneous histoplasmosis was diagnosed on microscopic examination of bone marrow and skin biopsy and was confirmed by fungal culture of bone marrow & blood. histoplasmosis commonly affect immunocompromised individual, presentation varies from primary pulmonary histoplasmosis, disseminated histoplasmosis. Our case represents a unique as histoplasmosis is rarely seen in paediatric age group and Indian population