Primary Cutaneous Histoplasmosis

An 80-year-old farmer with arthritis, anemia, chronic kidney disease, and a history of shingles presented with a 3-month history of a painful, nonhealing, ulcerative pinna lesion refractory to antibiotics and local wound care (figure 1). Hemodialysis was initiated; however, the patient's health progressively deteriorated, and he passed away a few months later from renal-, heart-, and liver-associated complications H capsulatum is a soil saprophyte endemic to the Ohio and Mississippi River valleys, often found in chicken habitats or caves inhabited by bats and birds. Infection by inhalation of aerosolized H capsulatum microconidia primarily affects the lungs of immunosuppressed individuals, although a variety of clinical presentations exist.1 Histoplasmosis of the skin, a less common presentation, occurs either secondarily via systemic infection that disseminates to the skin, or primarily via direct inoculation of H capsulatum during injury to the skin.1,2 The latter disease process, termed primary cutaneous histoplasmosis (PCH), rarely presents in the head and neck and is poorly described in the otolaryngologic literature.3 Patients with PCH present with nonspecific skin lesions including papules, plaques, ulcers, purpura, abscesses, impetigo, or dermatitis.4 Diagnosis hinges on evidence of fungus in the wound and absence of systemic disease.