Cutaneous histoplasmosis successfully treated with oral itraconazole monotherapy in a human immunodeficiency virus positive female

Histoplasmosis is a deep fungal infection with a worldwide distribution that can affect both immunocompromised and immunocompetant individuals. The majority of cases with cutaneous involvement also have systemic disease. Intravenous amphotericin is commonly employed for its treatment which is associated with significant side effects. We hereby report a of case cutaneous histoplasmosis in a human immunodeficiency virus (HIV) positive female who was treated successfully with oral itraconazole monotherapy along with anti-retroviral therapy. A 38-year-old HIV-positive female presented with multiple asymptomatic skin colored umbilicated papular eruptions over face, neck, trunk, and upper extremities of two and half months duration. She did not have any systemic complaints. Histopathology of the lesion showed a diffuse dermal granulomatous inflammation with 2–4 µ sized round organisms in macrophages with a clear halo suggestive of histoplasmosis. Her CD4 cell count was 38 cells/mm3. She was started on highly active antiretroviral therapy (tenofovir 300 mg OD, lamivudine 300 mg OD, and nevirapine 200 mg BID) along with cotrimoxazole prophylaxis. The patient was also prescribed oral itraconazole 100 mg twice daily. After 20 weeks of therapy, the patient showed complete resolution of lesions with minimal scarring. Histoplasmosis in retrovirus positive patient is frequently treated with intravenous amphotericin. Our patient responded to long-term itraconazole monotherapy