Citation: Grimaud LM, Mallia D, Galea LA, Decelis S, Piscopo T. A case of disseminated histoplasmosis in a person with HIV. J Clin Images Med Case Rep. 2024; 5(3): 2946.

Description

Background: Disseminated histoplasmosis is an AIDS-defining infection caused by the fungus Histoplasma capsulatum. At CD4 counts <150 cells/µl, reactivation and dissemination of previously acquired histoplasma infection may occur, with devastating clinical consequences.

Method: We report a case of disseminated histoplasmosis diagnosed in a severely ill migrant with HIV. This young man of Ghanaian origin had prolonged fever, weight loss, hepatosplenomegaly, cervical and inguinal lymphadenopathy and pancytopenia. His CD4 count was 1 cell/µl on admission to hospital. The case report describes how other diagnosis were considered, including visceral leishmaniasis and disseminated mycobacterium avium complex infection, prior to detection of growth of Histoplasma capsulatum from bone marrow. The yeast has been identified as Histoplasma capsulatum var capsulatum.

Discussion: This was the first diagnosed case of disseminated histoplasmosis in Malta. The report highlights the difficulty of establishing a diagnosis of an infection which is not endemic in Europe. The importance of sending tissue samples for mycology analysis is also emphasized in this report.

Conclusion: Disseminated histoplasmosis should be considered in the differential diagnosis of severely immunocompromised patients with HIV. A high index of clinical suspicion should be maintained throughout, as timely treatment with antifungals and antiretroviral infection improves prognosis for what would otherwise be an invariably fatal condition.