Indigenous case of disseminated histoplasmosis, Taiwan

Abstract

We report the first indigenous case of disseminated histoplasmosis in Taiwan diagnosed by histopathology of bone marrow, microbiologic morphology, and PCR assay of the isolated fungus. This case suggests that histoplasmosis should be 1 of the differential diagnoses of opportunistic infections in immunocompromised patients in Taiwan.

Figure 1

Bone marrow examination of patient A bone marrow biopsy specimen showing numerous oval-shaped intracellular and extracellular microorganisms (A and B). A bone marrow aspiration smear showed numerous intracellular yeastlike microorganisms (C and D). A) hematoxylin and eosin stain, 1,000×; B), periodic acid–Schiff stain, 1,000×; C), Gram stain, 1,000×; and D), Wright stain, 1,000×.

Figure 2

A) Colony of the mold from the patient is white-brown with a cottony appearance on Sabouraud dextrose agar. B) Lactophenol Cotton Blue Stain (Hardy Diagnostics, Santa Maria, CA, USA) of the isolated mold showing thick-walled and tuberculate macroconidia (arrowheads) and microconidia (arrows). C) PCR assay for identification of Histoplasma capsulatum based on the nucleotide sequence of the M antigen. PCR products included 111-bp and 279-bp fragments amplified with primers Msp1F-Msp1R (pair 1) and Msp2F-Msp2R (pair 2), respectively, which confirmed the identification of H. capsulatum (8). M, molecular mass marker.