Case Report: Primary Cutaneous Histoplasmosis in an Immunocompetent Patient After Cosmetic Injection of Platelet-Rich Plasma Treated with Trimethoprim-Sulfamethoxazole

Background: Histoplasma capsulatum is a spore-forming fungal organism found in soil that is considered endemic in Venezuela. Histoplasmosis has 3 different clinical presentations that primarily affect immunocompromised individuals. A type of injectable dermal cosmetic treatment uses platelet-rich plasma (PRP). This report is of a 35-year-old immunocompetent Venezuelan woman with primary cutaneous histoplasmosis (PCH) following cosmetic injection of PRP. Case Report: This report presents a rare case of PCH following a cosmetic procedure of PRP injection in a 35-year-old immunocompetent patient, who was initially treated with self-administered antibiotics. During her first appointment, an atypical mycobacterial infection was suspected, and empirical antibiotic therapy targeting these pathogens was initiated. Complementary tests were conducted, ruling out immunosuppression and systemic infections. After 1 month of treatment with trimethoprim-sulfamethoxazole, the lesions had completely resolved. Pathological examination confirmed the diagnosis of PCH with intracytoplasmic inclusions of Histoplasma. In this case, the patient had no evident risk factors for PCH, and it is suspected that the infection was likely introduced during the PRP procedure due to inadequate hygiene measures. Conclusions: This case demonstrates that PCH can arise in immunocompetent patients, emphasizing the need to include histoplasmosis as a diagnostic option, particularly in endemic locations. Direct inoculation of Histoplasma might occur following aesthetic procedures that do not follow basic hygiene precautions. Finally, trimethoprim-sulfamethoxazole can be considered an alternate therapy option, and additional research into this strategy may benefit patients with similar clinical circumstances or when optimal treatment options are unavailable.