Histoplasma Panniculitis in Dermatomyositis

This report describes the coexistence of infectious panniculitis due to Histoplasma capsulatum in three patients with dermatomyositis. In each case, the appearance of panniculitis was the predominant clinical manifestation of histoplasmosis. Oral ulcers, lymphadenopathy, pulmonary infiltrates, hepatosplenomegaly, and other cardinal features of disseminated histoplasmosis were notably absent. The clinical presentation of panniculitis may initially be interpreted as worsening of dermatomyositis and can lead to delay in diagnosis and institution of antifungal therapy.Histoplasmosis should be placed high on the differential diagnosis whenever symptomatic panniculitis is observed in the setting of myositis. Clinicians should not be reluctant to perform full thickness biopsies in patients with panniculitis who are on immunosuppressive therapies. Antifungal therapy and reduction in corticosteroids resulted in excellent clinical response with no relapse of infection in this small series.