African Histoplasmosis Misdiagnosed as Tuberculosis: A Case Report and Literature Review

Authors: Omega Phillip* , Musoke S , Tonny O , Mawanda A , Boaz M , Asiimwe I , Okello M , Gladys A , Wanyeze E , Byebei E , Masumba JD , Nakayemba J , Kyakoonye M , Atuhura R , Nsobya G , Lukande R , Bukirwa P , Namwase B , Musoke S , Yekosani M , Kakooza F and Kalungi S

DOI: 10.23880/cprj-16000213

Volume 8, Issue 1

Abstract

African histoplasmosis, caused by Histoplasma capsulatum var. duboisii, is a rare fungal infection endemic to sub-Saharan Africa, including Uganda. It primarily affects the skin, subcutaneous tissues, and bones, often mimicking more common conditions such as tuberculosis (TB). This report describes a 35-year-old Ugandan male who presented with a chronic, non-healing ulcer on his upper right arm, initially misdiagnosed and treated as TB for three months without improvement. Histopathological analysis of a biopsy revealed granulomatous inflammation with large, thick-walled yeasts characteristic of H. capsulatum var. duboisii, confirmed using Grocott methenamine-silver and Periodic Acid-Schiff stains. The patient was subsequently treated with itraconazole, resulting in significant clinical improvement. This case highlights the diagnostic challenges of African histoplasmosis in resource-limited settings and emphasizes the critical role of histopathology in differentiating it from other chronic infectious diseases. Increased clinician awareness and diagnostic capacity are essential for timely and accurate diagnosis.

Keywords: African Histoplasmosis; Granuloma; Cutaneous Ulcer; Histopathology; Fungal Infections

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