Adventures in fly fishing: An unexpected catch?

ABSTRACT: 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.