To the Editor.—
Disseminated histoplasmosis is increasingly recognized in patients with acquired immunodeficiency syndrome (AIDS). We describe a patient with longstanding psoriasis who presented to our clinic with unusual-appearing herpetiform lesions that, after biopsy, showed cutaneous histoplasmosis. A subsequent test for the presence of AIDS proved to be positive. The patient repeatedly denied any risk factors.
Report of a Case.—
The patient was a 38-year-old white man with a 42-month history of widespread psoriasis and severe psoriatic arthritis. The severity of the joint involvement had resulted in the patient being confined to a wheelchair. Methotrexate had been employed by his rheumatologist (total received dose of 2205 mg). He presented to our dermatology clinic with complaints of malaise, fever, and odynophagia for 3 weeks, along with a 2-day history of a mucosal and perioral eruption. Examination revealed multiple partly grouped vesicles and pustules in the perioral area (Fig 1), along with
Bundy AT, Simjee S, Ray M, Ristow H. Psoriatic Patient Presenting With Perioral Herpetiform Lesions. Arch Dermatol. 1989;125(10):1440-1441. doi:10.1001/archderm.1989.01670220138032