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Generalized granuloma annulare‐like eruption secondary to acute Epstein–Barr virus infection.

monary focus and are common in immunocompromised states. In a previous case series of immunocompetent patients with histoplasmosis from India, mucocutaneous involvement was present in nearly 36% of the cases. However, it is essential to note that most of these cases had either mucosal or associated systemic involvement, and most cases of isolated cutaneous histoplasmosis presented with one or few localized lesions. There are very few reported cases of disseminated histoplasmosis in the immunocompetent cases, where the patients presented with only cutaneous lesions. A literature review of such patients from India revealed only 18 cases over a period of 14 years (2001–2015). Our case is unique in terms of extensive skin involvement without any history of exposure to highrisk areas and trauma, which could result in the inoculation of the pathogen. Hence, it is difficult to label this case as a primary cutaneous form of histoplasmosis. Also, since no active or healed focus of infection could be demonstrated in the lungs, it is difficult to explain the portal of entry of the pathogen as well as selective affection of the skin. A possible explanation for such clinical presentation could be due to a good immunity that resulted in fast and complete resolution of the primary pulmonary focus. Even in such a scenario, it is difficult to explain why the cutaneous lesions continued to progress. We chose itraconazole for treating this patient, on account of ease of oral administration at home and better safety profile as compared to amphotericin B. We are reporting this case on account of rare clinical presentation of disseminated cutaneous histoplasmosis without mucosal and systemic involvement in an immunocompetent female patient.