Patients with advanced HIV-1 disease can present with a vast array of opportunistic infections. Not only is the spectrum of disease more
diverse, but the spectrum of presentation can vary significantly from what is expected. In this case report we describe a patient with
advanced HIV-1 disease presenting disseminated skin lesions and haematological abnormalities. Upon further investigation, a probable
diagnosis of disseminated histoplasmosis was established. The patient was subsequently treated with oral itraconazole and showed
marked haematological and clinical improvement within six weeks of therapy. Histoplasmosis is an opportunistic infection endemic to
South Africa and, like most opportunistic infections, can present with a myriad of clinical features which can complicate early diagnosis.
Although not as prevalent as in other parts of the world, it should always be considered as part of the differential diagnosis, especially
among severely immunocompromised individuals.