Article Text

Download PDFPDF
Erythema nodosum as key manifestation of histoplasmosis case
  1. Susanna Wang1 and
  2. Jennifer Morrical2
  1. 1Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
  2. 2Internal Medicine and Pediatrics, Holland Hospital, Holland, Michigan, USA
  1. Correspondence to Susanna Wang; wangsusa{at}


Histoplasmosis is a systemic infection caused by the fungus, Histoplasma capsulatum. Infection of H. capsulatum frequently occurs by inhaling the spores of the fungus, which is found in bat and bird droppings, or soil enriched with their excrement. If not detected and treated, histoplasmosis can develop late, severe complications such as mediastinal fibrosis, or even develop into a disseminated infection. However, histoplasmosis infections are often asymptomatic, making its detection more difficult. Further, only 6% of histoplasmosis cases will present with erythema nodosum, with most cases associated with female patients. This case presents a woman in her 50s with a pertinent history of fibromyalgia and hypothyroidism secondary to Hashimoto’s who initially sought medical care for painful nodules on her legs and was eventually diagnosed with histoplasmosis. This report clearly demonstrates the importance of maintaining a broad differential when working up inflammatory manifestations, such as erythema nodosum.

  • Exposures
  • Systemic lupus erythematosus
  • Vasculitis
  • Cryptococcus
  • Dermatology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors SW, Michigan State University College of Human Medicine, made substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of the work; drafting the work and critically revising the work. JM, Holland Hospital, served as scientific advisor, critically reviewed the study proposal, and gave final approval of the version of this study to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.