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The skin biopsy specimen revealed sheets of epithelioid-type histiocytes throughout the dermis, which was densely parasitized by organisms, with a focal necrotizing tuberculoid-type granuloma within the superficial dermis that was composed of an admixture of epithelioid-type histiocytes and lymphocytes. The patient underwent an exploratory laparotomy with partial ileocecotomy and resection of a mesenteric mass. Culture of the resected tissue revealed Histoplasma capsulatum var capsulatum. One week of treatment with amphotericin B followed by itraconazole therapy (200 mg twice a day) resulted in resolution of the patient's systemic symptoms and eruption.
Papular Eruption in an HIV-Infected Man—Diagnosis. Arch Dermatol. 2007;143(2):255-260. doi:10.1001/archderm.143.2.255-f