Leonine facies and hoarseness in disseminated histoplasmosis: A diagnostic pitfall.

This article focuses on a case of disseminated histoplasmosis in a 56-year-old immuno-competent male from a non-endemic region in India, presenting with progressive weight loss, hoarseness, leonine facies, genital nodules, and widespread cutaneous lesions. Diagnosis was confirmed through elevated urine Histoplasma antigen levels, skin biopsy showing intracellular yeast-like organisms, and polymerase chain reaction (PCR) detection of Histoplasma capsulatum DNA. Magnetic resonance imaging suggested probable laryngeal involvement, and the patient responded well to treatment with liposomal amphotericin B followed by itraconazole for 12 months. The case underscores the emerging occurrence of histoplasmosis in immuno-competent individuals outside endemic areas and highlights the importance of dermatological evaluation and targeted fungal testing in systemic mycoses.