Histoplasmosis Due to Histoplasma Capsulatum Var. Duboisii: Diagnostic Difficulties in Decentralized Areas

Introduction: Histoplasmosis caused by Histoplasma capsulatum var. duboisii is a deep mycosis that is rampant in Africa. Clinical manifestations are dominated by skin involvement. It is a condition that sometimes poses diagnostic and therapeutic problems. Observation: We report the case of an 81-year-old non-smoking, non-alcoholic patient who presented with polymorphic cutaneous lesions in the form of gums of variable size disseminated on the trunk and the limbs at the stage of rawness or softening, an ulcerative lesion crusty measuring 5 cm on its longest axis sitting at the level of the abdomen and an ulceration measuring 6 cm on its longest axis with purulent and hemorrhagic background with raised edges and indurated base at the level of the right subclavicular region. This picture had been evolving for 9 months in a context of impaired general condition and exertional dyspnoea at stage IV. Pulmonary examination revealed bilateral pleural effusion syndrome. Examination of the lymph nodes revealed no superficial adenopathy. African histoplasmosis was suggested. Retroviral serology and syphilitic serology were negative. The thoraco-abdomino-pelvic computed tomography showed a tumoral process at the apical level of the right lung at the level of the ventral segment of the upper lobe and multiple secondary localizations in the right mediastino-hilar lymph nodes under the skin and bone. The diagnosis of histoplasmosis was retained by the pathological examination of the skin biopsy, which was in favor of histoplasmosis and mycology confirmed histoplasmosis due to Histoplasma capsulatum var. dubosii. The evolution was marked by the death of the patient before the treatment. Conclusion: African histoplasmosis remains a rare condition although a few cases are reported in the literature. Its clinical polymorphism often confuses practitioners.