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Laboratory investigations showed a CD4 count of 42 cells/μL and a plasma HIV-1 level of 153 024 copies/mL. Chest radiography and abdominal sonography findings were normal. Histopathologic analysis showed focal ulceration and parakeratosis in the epidermis and a diffuse histiocytic infiltrate with neutrophils in the dermis. Small round to oval microorganisms were seen within and outside histiocytes under routine hematoxylin-eosin staining. Staining with GMS revealed small round to oval fungi. Culture on Sabouraud dextrose agar at 27°C yielded a cottony white colony characteristic of Histoplasma capsulatum, variation capsulatum, after 4 weeks.
Widespread Crusted Lesions in a Patient With HIV—Diagnosis. Arch Dermatol. 2009;145(12):1447–1452. doi:10.1001/archdermatol.2009.286-b