Roy Moni, Roy Ashish Kumar, Upalakalin Jan Nalinee, Ahmad Sharjeel
Department of Internal Medicine, University of Illinois College of Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, USA.
Department of Pathology, OSF Saint Francis Medical Center, Peoria, Illinois, USA.
Eur J Case Rep Intern Med. 2020 Jul 16;7(10):001814. doi: 10.12890/2020_001814. eCollection 2020.
Disseminated histoplasmosis is most commonly caused by and is a known opportunistic infection in immunocompromised patients. The clinical presentation of histoplasmosis varies from asymptomatic to a progressive disseminated form. Pulmonary and CNS involvement is common in disseminated histoplasmosis. Rarely, disseminated disease can present as vulvar lesion in the absence of pulmonary symptoms, causing a delay in diagnosis. As per our PubMed literature search, there have only been two reported cases where vulvar lesion was the only presenting symptom of disseminated disease. In our patient, a histopathological diagnosis was made with staining showing budding yeast forms of histoplasma.
Histoplasmosis can be a cause of isolated non-resolving vulvar lesion in immunocompromised patients.In patients at risk, we recommend work-up for disseminated histoplasmosis with urine histoplasma antigen and further imaging to rule out disseminated infection when histoplasma is identified on local biopsy samples.In patients from endemic regions and in non-resolving vulvar lesions, fungal infection should be considered.
播散性组织胞浆菌病最常见的病因是……，并且是免疫功能低下患者已知的机会性感染。组织胞浆菌病的临床表现从无症状到进行性播散形式不等。播散性组织胞浆菌病常见肺部和中枢神经系统受累。罕见的是，播散性疾病可在无肺部症状的情况下表现为外阴病变，导致诊断延迟。根据我们对PubMed文献的检索，仅有两例报道称外阴病变是播散性疾病的唯一表现症状。在我们的患者中，通过染色显示组织胞浆菌的芽生酵母形式做出了组织病理学诊断。
组织胞浆菌病可能是免疫功能低下患者孤立性、不消退的外阴病变的病因。对于有风险的患者，当在局部活检样本中鉴定出组织胞浆菌时，我们建议通过检测尿组织胞浆菌抗原对播散性组织胞浆菌病进行检查，并进一步进行影像学检查以排除播散性感染。对于来自流行地区且外阴病变不消退的患者，应考虑真菌感染。
