HISTOPLASMA CAPSULATUM may cause several types of cutaneous manifestations. Disseminated histoplasmosis has been most commonly associated with oral mucocutaneous ulcers,1-3 which may persist longer than three months. The progressive cutaneous form of disseminated histoplasmosis may appear as granulomas, ulcerations, or papulonecrotic lesions. Differentiation of these lesions from other cutaneous ulcers on clinical grounds alone is difficult if not impossible. Etiologic confirmation is determined by isolating H capsulatum, usually from a biopsy specimen.
Primary cutaneous histoplasmosis, in which the organism is confined to the skin, is uncommon. To our knowledge, only three verified cases have been reported.4-6 Furcolow7 has reviewed previous possible cases. In each of the three verified cases, the infection was self-limited without systemic therapy. The purpose of this report is to present a fourth case of apparent primary cutaneous histoplasmosis. The disease in this immunosuppressed patient differed from previously reported cases of primary cutaneous histoplasmosis in being