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Adventures in Fly Fishing: An Unexpected Catch?

Costilla, Vanessa C. MD*; Funtowicz, Luciana MD; Blair, Janis E. MD

Infectious Diseases in Clinical Practice: November 2013 - Volume 21 - Issue 6 - p 398–400
doi: 10.1097/IPC.0b013e31827f4486
Case Report

Histoplasma capsulatum is a dimorphic fungus endemic to the Ohio Mississippi River Valley. We present a unique case of disseminated Histoplasma capsulatum presenting cutaneously in an immunocompromised patient with no significant exposure to endemic areas. The mechanism of her exposure reminds us that a thorough history can provide important clues to a diagnosis. This case also highlights how results of positive diagnostic tests may be misleading. Our patient had positive coccidioidal antibody by complement fixation. However, it was not until the true origin was identified and treated that her lesions improved.

From the *Department of Internal Medicine, Divisions of †Consultative Medicine; and ‡Infectious Disease, Mayo Clinic, Scottsdale, AZ.

Correspondence to: Luciana Funtowicz, MD, Division of Consultative Medicine, 13400 East Shea Blvd, Scottsdale, AZ 85259. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2013 by Lippincott Williams & Wilkins.