Disseminated fungal infection in an Immunocompetent host

An apparently healthy 50-year-old male, reported in OPD with the history of fever for last 1 year associated with decreased appetite and weight loss in last 6 months and skin rash all over body for last 4-6 weeks. On physical examination, the patient was looking ill. He was febrile, pale, tachycardic and blood pressure was within normal range. Axillary lymph nodes were enlarged, right was approximately of6cms x 4 cms, and left was 3cms x 4 cms, firm, non-tender and mobile. He had raised skin lesions of varying sizes 0.5-1 cms all over body including the genitals, sparing palm and sole. Rash was not associated with redness, pain, itching or any discharge. Bilateral ulnar nerves were thickened. Abdominal examination revealed a moderately enlarged non-tender liver and palpable spleen. Cardiovascular, respiratory system and nervous system examination were normal. Provisional diagnosis of Lepra Reaction/ skin manifestation of lymphoma / infective etiology such as Tuberculosis, Fungal infection and Human immunodeficiency virus (HIV) was kept. After bone marrow examination and biopsy from the skin lesion patient was ultimately diagnosed as disseminated fungal infection. Patient was initiated on treatment with colloid amphotericin B IV for 3 days followed by oral itraconazole 200 mg BD. On follow - up patient is doing well his lymph nodes have disappeared his fever has subsided and skin lesions are regressing. He is still on followup.