Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jul 1;12(7):e8945.
doi: 10.7759/cureus.8945.

Culture-Proven Disseminated and Meningeal Histoplasmosis Presenting as Septic Shock and Autoimmune Hemolytic Anemia in an Infant

Fabricio Sevilla-Acosta  1   2 , Elisandro Jiménez-Cruz  3 , Hazel Álvarez-Cabalceta  3 , Rolando Ulloa-Gutierrez  4
Affiliations
Case Reports

Culture-Proven Disseminated and Meningeal Histoplasmosis Presenting as Septic Shock and Autoimmune Hemolytic Anemia in an Infant

Fabricio Sevilla-Acosta et al. Cureus. .

Abstract

Disseminated histoplasmosis is the most common clinical presentation of histoplasmosis in human immunodeficiency virus (HIV) negative infants from Costa Rica and Latin America. Initial presentation as septic shock and autoimmune hemolytic anemia is uncommon. Even more, detection of Histoplasma capsulatum by culture in peripheral blood and cerebrospinal fluid (CSF) is extremely rare. We describe the case of a three-month-old Costa Rican immunocompetent infant who presented with shock and hemolytic anemia secondary to disseminated histoplasmosis that was confirmed by bone marrow aspirate and positive peripheral blood and CSF cultures.

Keywords: autoimmune hemolytic anemia; disseminated histoplasmosis; infants; septic shock.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The patient on admission to the community hospital had (a) mottled skin with reticular aspect (arrow) and (b) severe hepatosplenomegaly also visible on abdominal plain X-ray film (asterisks).
Figure 2
Figure 2. Cultures of peripheral blood and CSF.
(a) Fungal cultures of peripheral blood and CSF in Sabouraud’s dextrose agar and Mycosel agar. (b,c) Macroscopic growing of Histoplasma capsulatum filamentous colonies. (d) Tuberculate macroconidia of 8-15 µm (arrow) and microconidia of 2-4 µm of diameter (arrowhead) characteristic of H. capsulatum colonies in blue lactophenol. CSF, cerebrospinal fluid
See this image and copyright information in PMC

References

    1. Histoplasmosis in children. Fischer GB, Mocelin H, Severo CB, Oliveira Fde M, Xavier MO, Severo LC. Paediatr Respir Rev. 2009;10:172–177. - PubMed
    1. Disseminated histoplasmosis in infants. Odio CM, Navarrete M, Carrillo JM, Mora L, Carranza A. Pediatr Infect Dis J. 1999;18:1065–1068. - PubMed
    1. Pediatric Histoplasmosis in an area of endemicity: a contemporary analysis. Ouellette CP, Stanek JR, Leber A, Ardura MI. J Pediatric Infect Dis Soc. 2019;8:400–407. - PubMed
    1. Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Wheat J, Myint T, Guo Y, et al. Medicine (Baltimore) 2018;97:0. - PMC - PubMed
    1. Improvement in diagnosis of Histoplasma meningitis by combined testing for Histoplasma antigen and immunoglobulin G and immunoglobulin M anti-Histoplasma antibody in cerebrospinal fluid. Bloch KC, Myint T, Raymond-Guillen L, et al. Clin Infect Dis. 2018;66:89–94. - PMC - PubMed

Publication types

LinkOut - more resources