Disseminated Nodular Cutaneous Candidiasis in a Patient Living with HIV Receiving Ambulatory Care at Nkembo Hospital in Libreville: A Case Report

Abstract

Introduction: Candidiasis is a fungal infection of the skin and/or mucous membranes caused by Candida ssp, most commonly Candida albicans. Its presence is often favored by immunosuppression, obesity, maceration or humidity. The aim of this work is to report this atypical disseminated nodular clinical appearance of cutaneous candidiasis in an HIV-positive patient followed at the outpatient treatment center of Nkembo Hospital. This clinical presentation is rare; this is the first case described in Gabon. Observation: This is a 34-year-old patient, who consulted for hyperpigmented, ulcerated, diffuse scaly papulonodular lesions, with involvement of the upper and lower limbs, the anterior and posterior trunk, infiltrated with scaly and pustular red plaques in places on the face and ears, giving a pseudolepromatous appearance. Direct mycological examination of the scales reveals round and budding yeasts; culture revealed Candida albicans at 7 days. The diagnosis was nodular cutaneous candidiasis. The patient was placed on Sertaconazole cream and Fluconazole 200 mg/day (D1) then 100 mg/day/3 months and continued his TDF-3TC-DLG treatment. At the end of January 2023, we observed an almost complete subsidence of the lesions. Conclusion: Cutaneous candidiasis is diagnosed clinically in dermatological practice, the nodular and infiltrated appearance should be known, mycological examination should be used especially when associated with oropharyngeal candidiasis. Fluconazole remains effective against Candida albican and local treatment with a triazole is sometimes necessary.