Photo Quiz: A cutaneous fungal infection with discordant biomarker results—a diagnostic challenge

A woman with advanced HIV disease presented with unusual skin lesions that were initially suspected to be from a virus, but laboratory testing revealed a rare fungal infection called histoplasmosis caused by Histoplasma capsulatum. The case was challenging because some standard fungal tests came back negative even though the patient had the infection, showing why doctors need to rely on culture and examination under the microscope. She was treated with antifungal medications and her diagnosis highlights the importance of considering fungal infections in severely immunocompromised patients even when initial tests seem negative.