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Disseminated histoplasmosis with skin lesions and osteomyelitis in a patient from the Philippines. In the context of negative PCR tests and while waiting for culture results, Fontan and IHC stains may confirm the morphologic diagnosis of Histoplasma yeasts in decalcified bone biopsy specimens. Keywords: histoplasmosis; immunosuppression; osteomyelitis EN histoplasmosis immunosuppression osteomyelitis 1 3 3 12/23/22 20221201 NES 221201 CASE REPORT A 15-year-old boy with a history of kidney transplantation and ongoing immunosuppressive therapy presented with severe bilateral chest and abdominal pain. [Extracted from the article]

This case report discusses a pediatric patient who developed a hemodialysis catheter line infection from an uncommon etiology, Mycobacterium fortuitum. The initial presentation revealed a well appearing patient with a slow growing skin lesion near the site of the hemodialysis catheter. The treatment course was complicated by resistance to initial antibiotics leading to continued spread of the lesion. The diagnosis was confirmed via skin biopsy of the lesion that required 2 weeks to grow the atypical Mycobacterium. Treatment was successful after hemodialysis catheter removal, transition to peritoneal dialysis, and a prolonged antibiotic course. Mycobacterium fortuitum is a rare cause of dialysis catheter infections that is resistant to standard antibiotic treatment. Treatment success is improved after removal of the dialysis catheter and prolonged antibiotics based on susceptibilities. This case highlights the importance of keeping atypical Mycobacterium in the differential for patients with slow growing skin lesions near dialysis catheter sites with resistance to initial treatment. [ABSTRACT FROM AUTHOR]