48 Year Old Hiv + Male with Multiple Papules and Nodules on Arms

Figure 19.1

H&E 40×, Histoplasmosis, most of the entire punch biopsy specimen contains dense inflammation

Figure 19.2

H&E 100×, Histoplasmosis, confluent granulomas with scattered giant cells (arrow)

Figure 19.3

H&E 1,000×, Histoplasmosis, numerous small dot-like organisms are seen between cells (arrow)

The clinical appearance of multiple, small dome-shaped lesions such as warts, molloscum, and keratoacanthomas can be distinguished by microscopic examination which shows characteristic histoplasma organisms on routine H&E stains.

Treatment Options

Depending on the severity of disease and the immune status of the patient, itraconazole 200–400 mg daily is recommended. For patients with moderate to severe disease, amphotericin B (1 mg/kg IV daily) is used in combination with itraconazole.

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