Case Report Typical Facial Lesions: A Window of Suspicion for Progressive Disseminated Histoplasmosis—A Case of Asian Prototype Prasan K. Panda, 1 Siddharth Jain, 1 Rita Sood, 1 Rajni Yadav, 2 and Naval K. Vikram 1 1 Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110029, India 2 Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India Correspondence should be addressed to Naval K. Vikram; navalvikram@gmail.com Received 27 July 2016; Accepted 8 September 2016 Academic Editor: Larry M. Bush Copyright © 2016 Prasan K. Panda et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Histoplasmosis is caused by a dimorphic fungus Histoplasma capsulatum in endemic areas, mainly America, Africa, and Asia. In India, it is being reported from most states; however, it is endemic along the Ganges belt. We report a case of an apparently immunocompetent male who presented with 3-month history of fever, cough, and weight loss with recent onset odynophagia and had hepatosplenomegaly and mucocutaneous lesions over the face. he diferential diagnosis of leishmaniasis, tuberculosis, leprosy, fungal infection, lymphoproliferative malignancy, and other granulomatous disorders was considered, but he succumbed to his illness. Antemortem skin biopsy and bone marrow aspiration along with postmortem liver, lung, and spleen biopsy showed disseminated histoplasmosis. his case highlights the need for an early suspicion of progressive disseminated histoplasmosis in the presence of classical mucocutaneous lesions even in an immunocompetent patient sufering from a febrile illness. Cure rate approaches almost 100% with early treatment, whereas it is universally fatal if let untreated. 1. Introduction Classical histoplasmosis, also known as Darling disease, was irst discovered in 1906 [1]. It is an endemic mycosis, caused by two species known to be pathogenic to man (H. capsulatum var. capsulatum and H. capsulatum var. duboisii). H. capsulatum is highly endemic in North America along the rivers Ohio and Mississippi, but Southeast and Southern Asia have focal endemicity, which is underrecognized due to the low awareness of the disease, misdiagnosis of the disease oten as tuberculosis or leishmaniasis, and lack of proper diagnostic facilities [2]. “Asian histoplasmosis” as proposed difers from the American or African type, in having more mucocutaneous manifestations and a propensity for acute adrenal insuiciency, but the latter fact is disputed in many recent studies [3]. In India, the irst case of histoplasmosis was reported in 1954, following which many case reports, two successive systematic reviews, and three large hospital based retrospective studies have been published in the literature [4– 6]. A majority of cases have been reported from the eastern parts of the country, especially along the belt of Ganges and Brahmaputra, which may be related to the climate, humidity level, and soil characteristics. Due to migration and increased urbanization, cases are being reported from all over the country. Clinical suspicion should be high to diagnose cases in nonendemic areas. his fungus grows in soil enriched with bird drop- pings, reaches human alveoli through inhalation, and causes varied clinical presentations ranging from self-limiting lu- like illness or acute or chronic pulmonary histoplasmosis to progressive disseminated histoplasmosis, depending on the quantity of antigen exposure and immune status of the individual [6]. All organs can be involved during the process of dissemination, but the reticuloendothelial system, skin, adrenals, gastrointestinal tract, and lungs are the most commonly involved sites [7]. Henceforth, skin may act as a window for early diagnosis of disseminated histoplasmosis. We report an immunocompetent patient with dissem- inated histoplasmosis in whom an early suspicion of the disease may have improved the prognosis. Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2016, Article ID 2865241, 5 pages http://dx.doi.org/10.1155/2016/2865241